Is Medicare Different for Women?
Medicare is a national health insurance program for people 65 and older. However, you can qualify for Medicare under 65 due to specific disabilities. Since Medicare is a federal program, all eligible beneficiaries are entitled to Part A and Part B coverage. Part A provides inpatient hospital coverage, including room and board, meals, some medications in the hospital, hospice care, skilled nursing facility care, and home health care. Part B, on the other hand, provides outpatient medical coverage. Doctor visits, surgeries, physical therapy, and lab work fall under Medicare Part B.
Since Medicare does not cover health care costs 100%, many seniors purchase an additional plan such as Medigap plans, Medicare Advantage plans, and Part D plan. A beneficiary can enroll in one of these plans for cost-sharing assistance.
Although every beneficiary is entitled to Part A and Part B, some services or visits are designed for women. Keep reading to find out what those services are!
How does Medicare cover mammograms?
Screening mammograms are considered to be a preventive service under Medicare Part B. When women are 40 years old or older, they can get a screening mammogram every 12 months. Screening mammograms cost the beneficiary nothing as Medicare covers this preventive service 100%.
However, if a diagnostic mammogram is necessary, a woman can get this procedure more frequently than every 12 months. Since the diagnostic mammogram is different from the screening mammogram, the cost applies to the Part B deductible, and the beneficiary is responsible for the 20% coinsurance.
Additionally, a Medigap plan would help cover the 20% coinsurance for medically necessary diagnostic mammograms. If the beneficiary is enrolled in an Advantage plan, the procedure would have either a set copay amount or coinsurance.
Pelvic Exams and Pap smears with Medicare
Medicare can cover a pelvic exam and Pap smear once every 24 months. However, if there is a high risk of vaginal or cervical cancer or abnormal Pap smear results, Medicare can cover these procedures more frequently.
A beneficiary should not pay anything for these services if the provider accepts Medicare Assignment. Since Medicare Part B covers pelvic exams and pap smears 100%, an Advantage plan must cover these services 100% as well.
Osteoporosis is a medical condition found more commonly in women than men. When the bones become weak, fragile, and brittle, it increases the risk of broken bones and fractures.
Medicare covers a bone mass test every 24 months if:
- You’re a woman who is estrogen-deficient and at risk of this condition
- X-rays show possible osteopenia, vertebral fractures, or osteoporosis
- You’re taking prednisone or steroid-type drugs or planning to use this treatment
- You’ve been diagnosed with primary hyperparathyroidism
- You’re being monitored to see if osteoporosis drug therapy is working
A beneficiary should not pay anything for this test, and it can be covered more frequently if medically necessary.
If a beneficiary is diagnosed with osteoporosis, Medicare Part B can cover certain drugs needed for treatment. When a medication is not self-administered and instead is administered by a health care professional, it can be covered by Medicare Part B. However, there can be requirements when it comes to osteoporosis drugs.
Medicare Part B will cover the drug if you are a woman eligible for Part B and home health care services, has a bone fracture related to postmenopausal osteoporosis, and cannot administer the drug themselves and their family is unwilling or unable to administer it. You will be responsible for the Part B deductible and coinsurance unless you have a Medigap or Medicare Advantage plan.
Although the federal government provides Part A and Part B coverage to all eligible beneficiaries regardless of whether they are men or women, some services cater to women. You can check your plan’s Summary of Benefits for more information on your cost-sharing if you need a specific service.