How Does Medicare Cover OBGYN Visits?

Medicare generally covers medically necessary OBGYN visits and services for eligible beneficiaries, including preventive screenings, diagnostic services, and treatment. Understanding this coverage involves navigating Medicare’s different parts and associated costs.

Medicare Parts Covering OBGYN Services

Medicare Part B is the primary component covering most outpatient OBGYN visits, preventive screenings, and diagnostic services. It assists with costs for doctor’s services, outpatient care, and many preventive services. Routine office visits to an OBGYN fall under Part B coverage when medically necessary for diagnosis or treatment.

Medicare Part A covers inpatient hospital stays related to OBGYN care, such as surgery requiring hospital admission. It typically does not cover routine childbirth services.

Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits. Provided by private insurance companies, these plans must cover at least everything Original Medicare (Parts A and B) covers. Many also offer additional benefits, which can include extra OBGYN-related services, though specific benefits vary by plan and insurer.

Medicare Part D provides prescription drug coverage. While it does not cover OBGYN visits or procedures, it helps with the cost of prescription medications prescribed as part of OBGYN care, such as for infections or hormonal treatments.

Specific OBGYN Services Covered

Medicare covers various preventive OBGYN services. An annual wellness visit is covered, focusing on developing or updating a personalized prevention plan based on current health and risk factors. While not a full physical, this visit can include a discussion of gynecological health and a health risk assessment.

Routine screenings are covered, such as Pap tests for cervical cancer screening, typically once every 24 months. For higher risk individuals or those with a history of an abnormal Pap test within the past 36 months, Medicare may cover these screenings once every 12 months. Pelvic exams and clinical breast exams are generally covered at the same frequency as Pap tests.

Mammograms for breast cancer screening are covered. Medicare Part B covers one baseline mammogram for women aged 35-39 and one screening mammogram once every 12 months for women aged 40 and older. Diagnostic services, such as ultrasounds, biopsies, and lab tests, are covered when medically necessary to diagnose or treat a specific condition. Treatment for gynecological conditions like uterine fibroids, menopause symptoms, or infections is also covered when medically necessary.

Understanding Your Costs for OBGYN Care

Beneficiaries in Original Medicare can expect certain out-of-pocket costs for OBGYN services. For most services covered by Medicare Part B, a 20% coinsurance typically applies to the Medicare-approved amount after meeting the annual deductible. The annual deductible for all Medicare Part B beneficiaries is $257 in 2025.

Many preventive services are covered at 100% with no deductible or coinsurance, provided the healthcare provider accepts assignment. This includes annual wellness visits, screening mammograms, and Pap tests. If additional tests or services are performed during a preventive visit that are not covered under the preventive benefit, the Part B deductible and coinsurance may apply.

Medicare Advantage Plans (Part C) may have different cost-sharing structures compared to Original Medicare. These plans often feature fixed copays for doctor visits, including OBGYN appointments, or different deductible amounts. All Medicare Advantage Plans are subject to an annual out-of-pocket maximum, which limits the total amount a beneficiary pays for covered medical services in a year.

Finding OBGYN Providers Who Accept Medicare

Locating an OBGYN doctor who accepts Medicare is important. Confirm that the provider “accepts Medicare assignment,” meaning they agree to accept Medicare’s approved amount as full payment for services. This helps ensure the lowest out-of-pocket costs for the beneficiary.

Beneficiaries can utilize official resources to find providers. The “Care Compare” tool on Medicare.gov is a valuable resource for searching and comparing doctors and other clinicians enrolled in Medicare. This online tool allows users to filter by provider type and location and often indicates whether a provider accepts Medicare assignment. Directly contacting the provider’s office is also a reliable way to inquire about their Medicare participation status before scheduling an appointment.