Medicare Coverage for Cancer Prevention and Early Detection

Medicare pays for certain preventive health care services and some of the screening tests used to help find cancer. Talk to your health care provider about your cancer risk and what cancer screening tests you might need.

Breast cancer screening** (mammogram)

One screening mammogram every 12 months (1 year) is covered for all women with Medicare age 40 and older. You can get one baseline mammogram between ages 35 and 39, too. Medicare also covers newer digital mammograms. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment.

Note: Part B also covers diagnostic mammograms more frequently than once a year when medically necessary. You pay 20% of the Medicare-approved amount for diagnostic mammograms and the Part B deductible applies.

**Find information about the American Cancer Society cancer screening guidelines.

Cervical cancer screening**

Part B covers one Pap test and pelvic exam every 24 months (2 years). As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

Medicare covers these screening tests every 12 months (1 year) if you are at high-risk for cervical or vaginal cancer or if you’re of childbearing age and had an abnormal Pap test in the past 36 months.

Part B also covers Human papillomavirus (HPV) tests (as part of a Pap test) once every 5 years if you’re age 30 to 65 without any symptoms.

You pay nothing for the lab Pap or the lab HPV with Pap test if your doctor or other qualified health care provider accepts assignment. You also pay nothing for the Pap test specimen collection, pelvic exam and breast exam if your doctor or other qualified health care provider accepts assignment.

**Find information about the American Cancer Society cancer screening guidelines.

Colorectal cancer screening**

 

Screening fecal occult blood tests

Medicare covers screening fecal occult blood tests once every 12 months (1 year) if you’re 50 or older.

You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

Multi-target stool DNA lab test

This is covered once every 3 years if you meet all of these conditions:

  • You’re age 50 to 85.
  • You show no symptoms of colorectal disease including, but not limited to one of these:

Pain in the lower abdomen

Blood in your stool

Positive fecal occult blood test, fecal occult blood test, or fecal immunochemical test

  • You’re at average risk for developing colorectal cancer, meaning:

You have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.

You have no family history of colorectal cancer or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

Screening colonoscopy

Medicare covers screening colonoscopy once every 24 months (2 years) if you’re at high risk for colorectal cancer. If you aren’t at high risk for colorectal cancer, Medicare covers the test once every 120 months (6 years), or once every 48 months (4 years) after a previous flexible sigmoidoscopy. There’s no minimum age requirement.

You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

However, if a polyp or other tissue is found and removed during the colonoscopy, you may pay 20% of the Medicare approved amount of your doctor’s services and a copayment in a hospital setting. The Part B deductible doesn’t apply.

Screening flexible sigmoidoscopy

Medicare covers screening flexible sigmoidoscopy once every 48 months (4 years) for most people 50 or older. If you aren’t at high risk, Medicare covers this test 120 months (6 years) after a previous screening colonoscopy.

You pay nothing if your doctor or other qualified health care provider accepts assignment.

If a screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you may have to pay coinsurance and/or a copayment, but the Part B deductible doesn’t apply.

**Find information about the American Cancer Society cancer screening guidelines.

Lung cancer screening**

Part B covers the cost for a lung cancer screening with Low-Dose Computed Tomography (LDCT) once per year if you meet all of these conditions:

  • You’re over age 55.
  • You don’t have signs or symptoms of lung cancer (asymptomatic).
  • You’re either a current smoker or have quit smoking within the last 15 years.
  • You have a tobacco smoking history of at least 30 “pack years” (an average of one pack or 20 cigarettes per day for 30 years).
  • You get a written order from your doctor.

You pay nothing for this service if your doctor or health care provider accepts assignment.

**Find information about the American Cancer Society cancer screening guidelines.

Prostate cancer screening**

After discussing the benefits, limitations, and risks of prostate cancer screening with your doctor, you may or may not decide to get screened. If you decide to get screened, Part B covers digital rectal exams (DRE) and prostate- specific antigen (PSA) blood tests once every 12 months (1 year) for men over 50 (beginning the day after your 50th birthday).

  • Digital rectal exam: If your doctor performs this test, you pay 20% of the Medicare-approved amount for a yearly DRE and for your doctor's services related to the exam. The Part B deductible applies. If the DRE is done in a hospital outpatient setting, there is a copayment.
  • PSA test: If you get this lab test, you pay nothing for a yearly PSA blood test. If you get the test from a doctor that doesn’t accept assignment, you may have to pay an additional fee for the doctor’s services, but not for the test itself.

**Find information about the American Cancer Society cancer screening guidelines.

Tobacco use cessation***

(quitting smoking)

Part B covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month (1 year) period smoking. Over-the-counter drug treatments for tobacco cessation such as nicotine patches and gum are not covered by Medicare. Your Part D plan, however, might cover prescription drugs for tobacco cessation.

You pay nothing for the counseling sessions if your doctor or other health care provider accepts assignment.

***Find information about how to quit smoking.

To find more information, visit Medicare coverage.

 

 

 

 

 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Centers for Medicare and Medicaid Services (CMS). Medicare & you 2019. Accessed at www.medicare.gov/medicare-and-you on February 8, 2019.

Centers for Medicare and Medicaid Services (CMS). Preventative & screening services. Accessed at https://www.medicare.gov/coverage/preventive-screening-services on February 8, 2019.

US Department of Health and Human Services (HHS). Proposed changes to lower drug prices in Medicare advantage and part D. November 26, 2018. Accessed at https://www.hhs.gov/blog/2018/11/26/proposed-changes-lower-drug-prices-medicare-advantage-part-d.html?language=es on February 12, 2019.

 

Last Medical Review: May 13, 2019 Last Revised: May 13, 2019

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