Cancer screenings covered by Medicare

If found early enough, many cancers can be kept in check. Some even eradicated. To encourage early detection, Medicare pays 100% (in most cases) for screening tests. Your loved one may have a copay and/or Medicare percentage for the doctor’s exam to administer a test. Or a  facility fee for a colonoscopy. To get the most insurance coverage for screenings, look for doctors who “accept assignment” (accept what Medicare pays). With Medicare Advantage, they all do.

Remember, a screening test is preventive care. It means no cancer has been found as yet. These tests look for specific indicators. If a cancer diagnosis is made, payment for follow-up treatment, doctor visits, and testing falls within your loved one’s regular Medicare arrangement. Deductibles or copays may apply.

To secure a screening test, get an order from your relative’s primary care provider.

  • Lung cancer. Low-dose computed tomography (like a low-radiation X-ray). Medicare will pay for a yearly test for persons ages fifty-five to seventy-seven who don’t currently have signs of lung cancer. (Remember, this is for screening, not treatment.) They must also be a current smoker or have quit smoking within the past fifteen years.
  • Colon cancer. Occult blood tests once a year for people age forty-five and older. A flexible sigmoidoscopy or a colonoscopy is covered once every two to ten years. (They involve a look inside the colon.) The frequency depends on your loved one’s risk factors and any precancer findings on previous tests. If the procedure is done in a hospital setting, there is no deductible required for the hospital, but the facility may bill for a copay amount. If a polyp is discovered and removed, this goes from “screening”—no problems yet—to an actual medical procedure. Your loved one may then owe a copay and, for original Medicare, the percentage that is the patient’s responsibility.
  • Breast cancer. Mammogram once a year for women age forty and older.
  • Cervical and vaginal cancer. Pap smear and pelvic exam, typically once every two years. If your relative is high risk for these cancers or had an abnormal Pap smear in the past three years, Medicare covers the test and doctor’s exam once a year.
  • Prostate cancer. PSA blood test and/or a digital exam once a year for men age fifty and older. The blood test is covered 100%. There may be a charge if the doctor does a digital exam to look for an enlarged prostate.