Medicare Part B and Medicare Advantage cover cancer screenings when deemed medically necessary. To qualify, you may need to be in a specific at-risk age group or have other identifiable risk factors.
Medicare Part B and Medicare Advantage (Part C) will generally cover a variety of cancer screenings under certain conditions when a doctor deems these medically necessary. Usually, you have to belong to a certain at-risk age group or have other identifiable risk factors to receive coverage.
In certain cases, Part B will fully cover a certain number of cancer screenings in a calendar year, while in others, it will pay 80% of the cost once you meet the deductible. Part C will offer the same coverage as Part B, though some plans may cover screenings under additional circumstances.
Read on to learn the most common cancer screenings you get through Medicare.
Medicare Part B and Part C cover many screening tests that are used to help diagnose cancer when medically necessary. Many of these tests are free if your doctor accepts Medicare. These are:
- Breast cancer screening: Part B fully covers one annual mammogram for those 40 years old or older and a baseline test for those ages 35 to 39. It also covers medically necessary diagnostic mammograms, paying 80% of the cost after you meet the deductible.
- Colorectal cancer screening: Under specific conditions, Medicare fully covers one screening colonoscopy every 24 months, fecal occult blood tests once every 12 months, and multi-target stool DNA lab tests once every 3 years.
- Cervical cancer screening: Part B covers a Pap test and pelvic exam, including a breast exam, every 24 months, or every 12 months if you’re at high risk of breast cancer or had an abnormal Pap in the last 36 months. People ages 30 to 65 get a human papillomavirus (HPV) test with a Pap test every 5 years.
- Prostate cancer screening: Medicare Part B covers annual Prostate-specific antigen (PSA) blood tests and digital rectal exams (DRE) for people ages 50 or older. PSA tests are free if your doctor accepts Medicare, while DREs require meeting the Part B deductible and paying a 20% coinsurance.
- Lung cancer screening: Part B fully covers annual low dose CT lung cancer screenings for those 50 to 77 years old, if you’re asymptomatic, currently smoke or quit within the last 15 years, and have a 20-year history of smoking one pack per day.
- Skin cancer screening: Part B will cover a biopsy of a skin growth or sore when a dermatologist believes it may be cancerous. Once you meet the deductible, Part B will pay 80% of the cost.
If you get any of these screenings through Medicare Part C, your premiums, deductibles, and coinsurance for those tests that aren’t fully covered will vary.
Under Original Medicare, Part A covers inpatient cancer treatments like surgery, skilled nursing, home healthcare, blood transfusions, certain clinical studies, and breast prostheses post-mastectomy.
Meanwhile, Part B covers outpatient care, such as chemotherapy, radiation, doctor visits, diagnostic tests, outpatient surgery, and preventive screenings.
Part C (Medicare Advantage) provides the same benefits as Parts A and B, with possible additional benefits, while Part D covers prescription drugs, including some oral chemotherapy, anti-nausea, and pain medications, depending on the exact plan.
Generally speaking, Medicare should cover most medically necessary cancer screenings and treatments. However, Medicare doesn’t cover adjacent care that isn’t medically necessary, such as:
- room and board in assisted living facilities
- adult day care
- long-term nursing home care
- medical food or nutritional supplements (except enteral nutrition).
- help with personal tasks like bathing and eating
Medicare covers tests for various cancers, including breast, colorectal, cervical, prostate, and lung cancer. It’s a good idea to ask your doctor if they recommend these screenings for you based on your medical history or symptoms.
It’s also a good idea to ask why these tests are necessary, whether there are more affordable screening alternatives, and how long it may take to get the results.
You’ll also want to consider whether the test is Medicare-covered, what your out-of-pocket expenses may be, and whether your doctor and the facility performing the screening accept Medicare.
