Does Medicare Cover Cancer Screenings? 

Under normal conditions, cells grow and divide while the body rids itself of abnormal cells. Cancer results from a disruption in the cell turnover process when new cells grow uncontrollably and abnormal cells do not go away.

You may question the need for undergoing medical tests when you feel well, but some cancers are initially asymptomatic. If a screening reveals the presence of cancer, you can begin treatment right away. Early intervention, while a tumor is small and has not metastasized (spread), has the most chance of success.

Recommended cancer screenings

The American Cancer Society recommends the following screenings based on average risk, but your doctor may recommend a different schedule based on your age, lifestyle and family history: 

• 25-39: cervical
• 40-49: breast, cervical, colorectal and prostate
• 50 and older: breast, cervical, colorectal, lung and prostate

How Medicare Part B applies to cancer screenings

Medicare Part B (medical insurance) covers various screenings for specific ages. You pay nothing for most screenings when your healthcare provider accepts assignment. Use the provider search function on the official Medicare website to identify Medicare-participating providers. Medicare Advantage members should check the plan’s directory of network providers. Medicare Advantage may also offer more benefits than Original Medicare coverage. Let’s review some of the cancer screenings included with Medicare coverage.

Cervical and vaginal cancer screenings

Generally, Medicare covers a cervical and vaginal cancer screening, which includes a pelvic exam and Pap smear, every 24 months. Part B covers annual Pap tests for high-risk patients, including someone of childbearing age with abnormal Pap test results within the last 36 months. As part of the visit for a Pap test, you can get tested for Human Papillomavirus (HPV) every five years if you are asymptomatic and between the ages of 30 and 65.

Breast cancer screenings

Medicare covers a breast exam during the pelvic exam. For additional breast cancer screening, Part B includes one mammogram between the ages of 35 and 39, serving as a baseline, and an annual screening at age 40 and older. Your doctor may recommend a breast ultrasound If you have dense breasts.

Colorectal cancer screenings

Beneficiaries of any age at low risk of colorectal cancer can have a colonoscopy every 10 years or four years after undergoing a flexible sigmoidoscopy. Medicare covers the screening every two years for people at high risk. You will probably have the test in a hospital outpatient or at an ambulatory surgical center, so expect a facility charge of 15% coinsurance. The coinsurance also applies if your doctor removes any tissue, such as a polyp.

Prostate cancer screenings

Medicare covers bloodwork to measure blood levels of a protein called prostate-specific antigen (PSA). High PSA levels are indicative of many conditions, including prostate cancer. From the day after your 50th birthday, you can take the test every 12 months. 

Lung cancer screenings

Based on your smoking activity, smoking history and current age, your doctor may recommend lung cancer screenings. If you meet the criteria, Part B covers the cost of annual screenings, but you must first discuss the benefits and risks with your doctor. 

Getting support

Cancer affects not only people diagnosed with the disease but also the people who care for them. The American Cancer Society supports cancer patients, their families and any caregivers. Learn about programs, services and research at cancer.org. Other resources include the National Cancer Institute and the Centers for Disease Control and Prevention (CDC).