Does Medicare Cover HPV Testing?

Human Papillomavirus, or HPV, is a sexually transmitted infection that can cause mucous membrane growths as well as different types of cancer, mainly in the lower part of the uterus or the cervix. One way to learn if you have HPV is through running a test.

So a common question many people have is, “does Medicare cover HPV testing?” In this article, we answer that question in clear, plain English. You will also find the average costs of HPV tests and other helpful info.

Does Medicare Cover HPV Testing?

The short answer is yes; Medicare will cover the cost of HPV tests. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your HPV tests. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for HPV tests. Original Medicare provides coverage for HPV tests as part of their pelvic and pap smear tests. Original Medicare provides coverage for a pap smear test, breast exam, and pelvic exam every 24 months or 2 years.

Coverage for HPV tests, as well as pap smear tests, breast exams, and pelvic exams, are provided by Medicare Part B. However, Medicare Part B may provide coverage for these types of tests once a year or every 12 months if you meet the following conditions:

If you are at high risk of having cervical or vaginal cancer
If you are at childbearing age and you have had an abnormal pap smear in the last 3 years

You are considered at high risk for cervical cancer or vaginal cancer by Medicare Part B if you:

Were sexually active before the age of 16
Have had sexual interaction with five or more partners
Have had a sexually transmitted infection (in this case, HPV)
Your mother took the drug diethylstilbestrol (DES) during pregnancy
Have received three or fewer negative pap smears or no negative pap smears within the last seven years

However, if you are at the age of 30 to 65 and are not experiencing symptoms of HPV, Medicare Part B will provide coverage for an HPV test every 5 years.

Medicare Part B covers 100 percent of the costs of an HPV test, as well as pap smear tests, breast exams, and pelvic exams. That means you will no longer pay copayment or coinsurance.

Part C Coverage for HPV Testing

Medicare Advantage plans (Medicare Part C) also provide coverage for HPV tests. They cover everything Original Medicare covers and also typically offer some additional benefits as well. However, exactly what it covers and what your out-of-pocket are costs will vary depending on the specifics of your plan.

How Much Does An HPV Test Cost?

A single HPV test may cost somewhere from $30 or lower. However, in some cases, doctors may also charge clinic or office visits which add to the total costs.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.