Comprehensive Guide to Medicare Coverage for Well-Woman Exams

While Medicare does not offer a dedicated well-woman exam similar to the “Welcome to Medicare” wellness visit, it does cover essential screenings and doctor appointments that focus on female health care needs.

A typical well-woman exam involves screenings such as clinical breast exams, Pap smears (Pap tests), and pelvic exams, which can be performed by your primary care physician or a gynecologist.

Continue reading to understand how Medicare facilitates access to these important screenings and other beneficial services for individuals assigned female at birth (AFAB).

Understanding Medicare Wellness Exams for Women

Original Medicare Part B provides coverage for two key health and wellness visits: the initial “Welcome to Medicare” visit and an annual wellness visit thereafter.

The one-time “Welcome” visit, available within the first year of Medicare enrollment, involves a comprehensive review of your medical and social history. Following this, you are eligible for a yearly wellness checkup with your healthcare provider.

Additionally, Part B covers medically necessary visits to gynecologists if you exhibit symptoms or are at risk for gynecological conditions such as ovarian cysts, endometriosis, pelvic pain, urinary incontinence, or vaginal infections.

Urgent care visits for acute female health issues, like urinary tract infections (UTIs), are also covered under Part B, provided you see a Medicare-accepting healthcare professional.

Covered Screenings

During visits to your primary care doctor or gynecologist, you may receive screenings for cervical and vaginal cancers, including pelvic exams and Pap smears. Medicare generally covers these screenings every 24 months, but coverage may be more frequent if you are at high risk or have had abnormal results within the past 36 months.

Medicare Part B also covers other medically necessary tests for AFAB individuals, including:

• HPV Testing and Mammograms: HPV testing as part of a Pap test every 5 years for ages 30 to 65 without symptoms, and an annual mammogram or additional mammograms as medically required.
• Bone Mass Measurement: Bone density tests every 2 years if low estrogen levels and osteoporosis risk factors are present.
• Heart Disease Screening: Screening every 5 years for coronary heart disease risk factors, which are common among AFAB individuals.

For those enrolled in Medicare Advantage (Part C), coverage includes all Original Medicare benefits, with some plans offering additional screenings.

Cost of Well-Woman Screenings Under Medicare

Medicare Part B fully covers the “Welcome to Medicare” visit and annual wellness visits without coinsurance, as long as your provider accepts Medicare.

Other medically necessary visits and screenings may require you to pay 20% coinsurance after meeting your annual deductible, which is $257 in 2025. Monthly premiums for Part B start at $185, based on income.

Medicare Advantage plans have varying premiums, deductibles, and coinsurance amounts. The average Part C premium is approximately $17 per month in 2025, but enrollees must also continue paying their Part B premium unless their plan covers it.

Preparing for Your Well-Woman Exam: Questions to Ask Your Doctor

During your appointment, discuss any current symptoms, personal or family medical history, reproductive experiences, and menopause status. Your doctor may inquire about lifestyle factors such as smoking, exercise, and diet to tailor preventive care recommendations.

Consider asking your healthcare provider:

• Which screening tests are recommended for my age and health status?
• What vaccinations should I receive?
• Does my family history increase my risk for specific conditions?
• What lifestyle changes can improve my overall health?

If you experience anxiety during pelvic exams, inform your doctor so they can provide additional support and comfort.

Summary

Well-woman exams, including breast exams, Pap tests, and pelvic exams, are vital components of women's health and are typically administered by primary care providers or gynecologists.

Medicare Part B offers two key wellness visits: a one-time “Welcome to Medicare” appointment during your first year and an annual wellness visit thereafter, both of which can include these essential screenings.

Medicare also covers gynecological care for at-risk individuals and urgent care for acute female health issues, ensuring comprehensive support for women's health needs. Always confirm that your healthcare provider accepts Medicare to maximize your benefits.

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