Medicare and Medicaid cover specific cancer screenings
In this section, we provide information on coverage of cancer screenings under:
Medicare covers the following cancer screenings at 100% when the service is provided by a participating provider:
- Breast Cancer - one baseline mammogram for women ages 35-39; annual screening mammograms and 3D mammograms for women age 40 and older. As part of the “well-woman” pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.
- Cervical/Gynecologic Cancer - one Pap test and pelvic exam every 24 months. Medicare covers these screening tests every 12 months if you are at high-risk for cervical or vaginal cancer or if you are of childbearing age and had an abnormal Pap test in the past 36 months.
- Prostate Cancer - screening with digital rectal exams (DRE) and prostate-specific antigen (PSA) blood tests once every 12 months for men age 50 and over
- Colon Cancer - screening colonoscopy once every 24 months for those at high risk of colorectal cancer. There is no minimum age requirement. If you are not considered high risk for colorectal cancer, colonoscopy is covered once every 6 years, or once every 4 years after a previous flexible sigmoidoscopy.
Medicare generally does not cover cancer screenings beyond those outlined above, although some people have succeeded in getting coverage with Medicare Advantage or secondary insurance. Other cancer screenings, or more frequent screenings, may be considered diagnostic. In this case, the Part B deductible applies and patients pay 20% of the Medicare-approved amount.
Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about its coverage of cancer screenings.
Medicaid coverage of cancer screenings varies by state. Individuals who qualify for Medicaid based on their state’s decision to expand Medicaid under the ACA are entitled to the same screening and preventive services as those who are covered by private insurance. For people who qualify based on other traditional Medicaid eligibility pathways, cancer screening and preventive services are considered “optional” and the scope of coverage is determined by the state. However, most Medicaid programs do cover basic screening for breast, cervical, prostate and colorectal cancer.
Contact your Medicaid office to learn more about the coverage of cancer screenings in your state.