Medicare Coverage for Cancer Prevention and Early Detection

Medicare pays for certain preventive health care services and screening tests used to help find cancer before you have signs or symptoms.

Talk to your health care provider about your cancer risk and what cancer screening tests you might need. See The American Cancer Society Guidelines for the Early Detection of Cancer for more information.

Unless otherwise noted, you pay nothing for these tests under Medicare coverage IF your doctor accepts the Medicare-approved amount as full payment.

Ask your doctor if they are a Medicare provider before you schedule your appointment.

Breast

Women ages 35 to 39: One baseline mammogram (one time only)

Women ages 40 and older: One mammogram every 12 months (1 year)

 If medically needed, Medicare Part B covers diagnostic mammograms more than once a year. You would pay 20% of the Medicare-approved amount after meeting any Part B deductibles.

 Cervical

For most women at average risk: One pelvic exam and Pap test every 2 years.

For women at high-risk OR of child-bearing age and had an abnormal Pap test in the last 3 years: One pelvic exam and Pap test every 12 months (1 year).

For women ages 30 through 65 with no HPV symptoms: In addition to above, one HPV co-test (with Pap test) every 5 years.

Colorectal

People age 45 and over at average risk for colorectal cancer:

• One multi-target stool DNA test every 3 years (until age 85) *
• One fecal occult blood test every 12 months (need referral from doctor) *
• One barium enema every 4 years (when used instead of a flexible sigmoidoscopy or colonoscopy).  You pay 20% of the Medicare-approved amount for your doctor’s services. In a hospital outpatient setting, you also pay the hospital a copayment. Part B deductible doesn’t apply.
• One flexible sigmoidoscopy every 4 years or 10 years after a prior screening colonoscopy**
• One colonoscopy every 10 years or 4 years after a prior flexible sigmoidoscopy**

People age 45 and over and at high risk for colorectal cancer:

• One barium enema every 2 years. You pay 20% of the Medicare-approved amount for your doctor’s services. In a hospital outpatient setting, you also pay the hospital a copayment. Part B deductible doesn’t apply.
• One flexible sigmoidoscopy every 10 years after a screening colonoscopy **
• One colonoscopy every 2 years**

 *If you have a non-invasive stool-based screening test (fecal occult blood test or multi-target stool DNA test) and have an abnormal result, you are also covered for a follow-up colonoscopy.

**If your doctor finds and removes a lesion or growth during your flexible sigmoidoscopy or colonoscopy, you pay 15% of the Medicare-approved amount for your doctors' services. In a hospital outpatient setting or ambulatory surgical center, you also pay the facility a 15% coinsurance. In these cases, the Part B deductible doesn’t apply.

 Lung

People ages 50 to 77 who currently smoke, have quit in the last 15 years, or have a tobacco smoking history of at least 20 pack years (average 1 pack per day for 20 years): One low-dose CT scan every year

To be eligible for a low-dose CT scan for lung cancer screening, you must also have an order from your doctor and have NO signs or symptoms of lung cancer.

 Prostate

For men ages 50 and older:

• One digital rectal exam* (DRE) every 12 months; and
• One prostate specific antigen (PSA) blood test every 12 months

* For the digital rectal exam (DRE), you pay 20% of the Medicare-approved amount of a yearly DRE and doctor services, after your Part B deductible is met. In a hospital outpatient setting, you also pay a hospital visit copay.

 Help quitting tobacco

If you use tobacco: Up to 8 smoking and tobacco cessation counseling sessions in a 12-month period.