Does Medicare Cover Cancer Screening?
Original Medicare covers preventative care screenings related to many different types of cancer like breast cancer, cervical or vaginal cancer, prostate cancer, lung cancer, and colorectal cancer for Medicare beneficiaries. Most, but not all, preventive care services are performed without cost to the Medicare beneficiary. If you have a Medicare supplement, the supplement will pay (or credit you) your portion of any Medicare bill related to preventive care.
of course, Medicare also covers cancer treatment as detailed in our Medicare Cancer Treatment article.
What Part of Medicare covers cancer screenings?
Cancer screenings are covered under Medicare Part B. Medicare Part B is the outpatient insurance component of Medicare that covers a wide range of medically necessary services, including preventive services such as cancer screenings. Part B coverage is available to individuals who are eligible for Medicare and have enrolled in Part B.
How much does Medicare cover for cancer screenings?
Usually, Medicare Part B covers 100% of the cost for eligible cancer screenings. This applies as long as the screening is performed by a participating health care provider who accepts Medicare assignment.
But there are exceptions. For example, for prostate cancer screenings, normally, you pay 20% of the Medicare bill for digital rectal exams after the yearly Part B deductible and you pay nothing for the PSA test. Please see further details below.
More frequent prostate screenings may be considered diagnostic. In this case, the Part B deductible applies and patients (or their supplement) will be responsible for the 20% of the Medicare billP
What types of cancer screenings are covered by Medicare?
Medicare covers preventive care screenings for most types of cancer. The most common cancer screenings covered by Medicare include:
Mammograms
Medicare covers mammograms, which are X-ray exams of the breasts for breast cancer screening. The coverage includes both screening mammograms for early detection and diagnostic mammograms for further evaluation and medical care.
Medicare covers one baseline mammogram for women ages 35-39.
Medicare also covers screening mammograms once every 12 months for women who are 40 years of age or older. However, in certain cases, Medicare may cover mammograms for women under 40 if they have a high risk of developing breast cancer (for example, family history) or if it is medically necessary.
Medicare also covers other related services, such as breast ultrasounds and breast biopsies, if they are deemed medically necessary following a screening or diagnostic mammogram.
Pap Tests and Pelvic Exams
Medicare covers a Pap test and a pelvic exam to screen for cervical and vaginal
cancer. These tests are generally covered every 24 months, or every 12 months for high-risk individuals.
People with high cancer risk are women of childbearing age who have had an abnormal Pap test in the past or those who have a weakened immune system or a history of cervical cancer.
If an abnormality is detected during the exam, Medicare may cover further diagnostic tests, such as colposcopies or biopsies, to evaluate the condition, if medically necessary.
If you are between the ages of 30 and 65, Part B also covers human papillomavirus (HPV) tests ( part of a Pap test) once every 5 years.
If your doctor or other health care provider accepts assignment, you will pay nothing for these screenings:
the lab Pap test
the lab HPV with a Pap test
the Pap test specimen collection
the pelvic exam and clinical breast exam
Colorectal Cancer Screenings
According to the National Cancer Institute, fewer and fewer people have been developing colorectal cancer since the mid-1980s, mostly because more people have been getting screening tests and changing their lifestyle-related risk factors.
Medicare covers several types of colorectal cancer screenings, including colonoscopies (usually, every 10 years or once every 4 years after a previous flexible sigmoidoscopy), flexible sigmoidoscopies (once every 48 months or once every 24 months if at high risk), and fecal occult blood tests (usually, every 12 months).
Screening Barium Enema: Medicare pays for this test as an alternative to a colonoscopy or sigmoidoscopy once every 48 months for beneficiaries at average risk of colon cancer.
CT Colonography (Virtual Colonoscopy): Medicare may cover this test once every 48 months for beneficiaries at average risk, but only if performed in a doctor’s office or imaging facility.
A multi-target stool DNA lab test is performed once every three years if you’re aged 50 to 85, show no symptoms of colorectal disease, and are considered to be at average risk for developing colorectal cancer.
If you have a positive result on a screening FOBT, FIT, or stool DNA lab test, Medicare will cover the cost of a follow-on screening colonoscopy.
If your doctor or healthcare provider accepts Medicare assignment, you won’t have to pay anything for the screening test(s).
However, if your doctor discovers and removes a polyp or other tissue during the colonoscopy, you (or your supplement) will be responsible for paying 15% of the Medicare-Approved Amount. If the procedure is performed in a hospital outpatient setting or ambulatory surgical center, you will also need to pay a 15% coinsurance to the facility. The Part B deductible does not apply.
If flexible sigmoidoscopy leads to the biopsy or removal of a lesion or growth during the same visit, the procedure will be viewed as diagnostic and you may have to pay coinsurance and/or a copayment, but the Part B deductible won’t apply.
Prostate Cancer Screenings
Medicare covers prostate-specific antigen (PSA) blood tests (once every 12 months for beneficiaries who are 50 or older or sometimes as early as 40) and digital rectal exams (DREs) for the early detection of prostate cancer (once every 12 months for beneficiaries who are 50 or older). The frequency and coverage of prostate cancer screening depend on the individual’s age and risk factors.
Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. You will pay nothing for the PSA test.
Low-dose computed tomography scans to screen for lung cancer (LDCT)
LDCT is a recommended lung cancer screening method for individuals who meet specific criteria established by Medicare.
To be eligible for Medicare coverage of LDCT lung cancer screenings, you must meet the following criteria:
You must be 50-77 years old.
You don’t have signs or symptoms of lung cancer (asymptomatic).
You must be either a current smoker or have quit smoking within the last 15 years.
You get a written order from your doctor.
You must have a tobacco smoking history of at least 20 pack-years (1 pack-year is equivalent to smoking an average of one pack per day for 1 year).
Medicare pays the annual LDCT scan for cancer screening. However, coverage is contingent on the individual continuing to meet the eligibility criteria mentioned above.
You pay nothing for this service if your doctor or health care provider accepts assignment.
Remember, if you have a Medicare Advantage plan, it is not Original Medicare so your coverage for cancer screening and Medicare costs may be completely different. And seeing how much Medicare Part B covers for early cancer prevention, it’s a no-brainer to stick with it – or switch to it. Don’t let Medicare Advantage plans put you at a disadvantage. If you have an Advantage Plan, consider adding Cancer, heart Attack and Stroke Insurance to bring your coverage closer to that of a supplement.
Does Medicare cover radiation therapy?
Radiation therapy may be covered by either Medicare Part A or Part B. If you are an
inpatient, Part A will provide coverage for radiation therapy, and you will need to pay the Part A deductible and coinsurance as applicable.
But if you receive radiation therapy as an outpatient or at a freestanding clinic, Part B will provide coverage. In this case, you (or your supplement) will be responsible for paying 20% of the Medicare-approved amount. You may also pay the Part B deductible, if applicable, for therapy received at a freestanding clinic.
Does Medicare cover chemotherapy?
Medicare covers chemotherapy for cancer treatment. If you’re a patient in a hospital setting (hospital inpatient), Medicare Part A provides coverage, while Part B covers chemotherapy in a hospital outpatient setting, doctor’s office, or freestanding clinic as an outpatient.
For outpatient chemotherapy, the location of cancer treatment determines your cost. In a hospital outpatient setting, you’ll have a copayment. If you receive chemotherapy in your doctor’s office or a freestanding clinic, you’ll pay 20% of the Medicare-approved amount, along with the Part B deductible.
In addition, Medicare Part D plans may cover certain chemotherapy treatments and related prescription drugs for cancer patients. This may include anti-nausea drugs, oral prescription chemotherapy drugs, pain medication, or other cancer drugs or prescription drugs used as part of your cancer treatment plan.
Reach out to us today. Talk to an expert if you have any further questions about this or another Medicare coverage topic! Our award-winning Medicare agent team is always here to help you choose the best Medicare plan, save money, and feel at ease about your health insurance.
Sources:
https://medigapseminars.org/wp-content/uploads/2021/07/Guide-To-Medicares-Preventive-Services.pdf
https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
