Does Medicare Cover OB-GYN?

An OB-GYN, or obstetrician-gynecologist, is a healthcare provider that specializes in female reproductive health. Obstetrics mainly focuses on delivering babies and other services for pregnant women. On the other hand, gynecology focuses more on treatment and services for the female reproductive system.

If you are in need of an OB-GYN, you may be wondering, “does Medicare cover OB-GYN?” In this article, we answer that question in clear, plain English. You will also find the average costs of visits to the OB-GYN, as well as other helpful info.

The short answer is yes; Medicare will cover the cost of visits to the OB-GYN. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your OB-GYN visits. 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 OB-GYN visits. Coverage for a visit to the OB-GYN is provided by Medicare Part B. Medicare Part B provides coverage for services of an OB-GYN such as a pap smear test, a pelvic exam, and a breast exam.

Medicare Part B provides coverage for the services mentioned above once every 24 months. However, Medicare Part B may provide coverage for the said tests once every 12 months if you are at high risk of having cervical or vaginal cancer or if you are of childbearing age and have had an abnormal pap smear in the past 3 years.

Medicare Part B may consider that you are at high risk of developing cervical or vaginal cancer if you:

Are sexually active before the age of 16
Have had sexual intercourse with 5 or more different people
Have had an STD
Your mother took diethylstilbestrol (DES) during her pregnancy
Have received three or fewer negative pap smears within the last 7 years.

If you qualify, Medicare Part B will cover 100 percent of the Medicare-approved amount when you receive the service from a participating provider. In short, Medicare Part B will cover all of the costs.

If your healthcare provider discovered and needed to treat a new or existing problem during the tests, the care that you will receive will be considered as diagnostic care and Medicare Part B may bill you for it.

Part C Coverage for OB-GYN

Medicare Advantage plans (Medicare Part C) also provide coverage for an OB-GYN visit. By law, they have to cover everything that Original Medicare covers. However, these plan also offer coverage for additional healthcare services. The specific services they cover and how much it costs to get these services (and the plan itself) will vary from plan to plan.

How Much Does It Cost To Visit An OB-GYN?

A visit to an OB-GYN doctor may cost somewhere from $90 to over $500. Some special tests such as an amniocentesis test can even cost more than $2,500.

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.