Georgia Medicare Cancer Screenings: Coverage and Costs (2026)

If you have Medicare in Georgia, your major cancer screenings cost you $0 (no deductible, no coinsurance, no copay) as long as the provider accepts assignment. That covers screening mammograms, screening colonoscopy and flexible sigmoidoscopy, cervical (Pap) screening, the prostate PSA blood test, and low-dose CT lung screening for people who qualify.1

The cost risk sits in what happens next, not in the screening itself. When a screening turns up something and becomes diagnostic (a polyp removed during a colonoscopy, a follow-up diagnostic mammogram, a biopsy), cost-sharing can kick in. This guide is for the Georgia Medicare beneficiary deciding which screenings they can get at no cost, and what the exceptions are.

Brevy is an eldercare company helping families navigate Medicare, Medicaid, and senior-care decisions. This is education, not medical advice. For personalized screening recommendations, consult your doctor. For coverage questions, call 1-800-MEDICARE (1-800-633-4227).2

Why Georgia Medicare cancer screenings matter

The $0 rule takes cost out of the decision to get screened, but only for the screening itself. Colorectal screening shows where that line falls: a polyp found during a screening colonoscopy can be removed in the same procedure, and that removal is what turns a $0 screening into a visit with coinsurance.1

For most Georgians, the practical question is not whether these screenings are covered but which ones apply to them, when, and where the $0 stops.1 The sections below walk through each screening (who qualifies, how often, and what it costs), grounded in current Medicare rules.

Colorectal cancer screening

Medicare Part B covers screening colonoscopy and flexible sigmoidoscopy at $0 when the provider accepts assignment, within set intervals. A screening colonoscopy has no minimum age and is covered once every 120 months if you aren't at high risk (or 48 months after a previous flexible sigmoidoscopy), or once every 24 months if you are. A screening flexible sigmoidoscopy starts at age 45 and is covered once every 48 or 120 months, depending on your risk and your last test.1 High risk is broader than it sounds: one parent, sibling, or child who has had colorectal cancer or an adenomatous polyp is enough, as is your own history of adenomatous polyps or inflammatory bowel disease.1

The most common surprise bill is the polyp exception: if a polyp or tissue is removed, the screening becomes diagnostic and you owe 15% coinsurance on the Medicare-approved amount in 2026 (phasing down to $0 by 2030), plus a separate 15% facility coinsurance if it's done in a hospital outpatient department or ambulatory surgical center, with the Part B deductible waived; a Georgia dual-eligible in the QMB group cannot be billed that coinsurance at all.1,6 Test choices and schedules, the polyp phase-down, and worked Georgia examples live in our dedicated Medicare colorectal cancer screening in Georgia guide.

Screening mammography

Medicare Part B covers mammography under 42 CFR 410.34. A woman age 40 or older is covered for one screening mammogram every 12 months (payment is allowed once at least 11 months have passed following the month of the last one), and a woman ages 35-39 is covered for one baseline screening mammogram once in her lifetime. You don't need a doctor's referral for a screening mammogram. Baseline and screening mammograms cost $0 when the provider accepts assignment.3

When mammography is not $0

A diagnostic mammogram (furnished to a person with signs or symptoms of breast disease, a personal history of breast cancer, or a history of biopsy-proven benign breast disease) is not a $0 preventive service. After you meet the annual Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount, and a diagnostic mammogram may be furnished more than once a year when medically necessary.3 That can happen on the same day: when a diagnostic mammogram follows a screening one at the same visit, Medicare pays both, and the diagnostic study carries the deductible and the 20% even though the visit started as a $0 screening.3

3D mammography (tomosynthesis)

Medicare's billing codes for digital breast tomosynthesis (3D mammography) have been effective for dates of service on or after January 1, 2015. Screening DBT (HCPCS 77063) is billed together with the screening mammography code CPT 77067, and CMS states that the deductible and coinsurance don't apply to it, so a screening 3D mammogram is $0. Diagnostic DBT (HCPCS G0279) is billed together with a diagnostic mammogram (CPT 77065 or 77066), and the diagnostic mammogram carries the 20% after the deductible.3

Worked example: Patricia, age 72, Macon

Patricia has Original Medicare with a Medigap Plan G and has had annual screening mammograms for years. Her latest screening mammogram (billed as screening) is $0.3 The radiologist flags an abnormality and recommends diagnostic imaging and a biopsy. Those services convert to diagnostic billing with 20% coinsurance after the Part B deductible.3 Plan G doesn't cover the Part B deductible ($283 in 2026), so she pays that first if she hasn't met it yet this year; after that, Plan G pays her Part B coinsurance in full.7 The habit of annual screening is what caught the finding early.

Cervical cancer screening (Pap test)

Medicare Part B covers cervical and vaginal cancer screening, including the Pap test, at $0 when the provider accepts assignment. The Pap test is covered once every 24 months in most cases, or once every 12 months if you're at high risk for cervical or vaginal cancer, or of child-bearing age and had an abnormal Pap test in the past 36 months.1

Medicare defines high risk for this test, and one item on the list is easy to miss: a woman who hasn't had three negative Pap tests in the previous seven years meets it on that basis alone, which puts her on the 12-month schedule.1 Many women reach Medicare age with a long history of normal results, so whether to keep screening is a decision to make with your provider based on your history.

Prostate cancer screening

Medicare covers two prostate cancer screening tests for men over 50 (starting the day after the 50th birthday), each once every 12 months: the PSA blood test and the screening digital rectal exam (DRE). The two tests have different cost-sharing.4

The PSA is $0, the DRE is not

The PSA blood test itself costs $0. The screening digital rectal exam is not a $0 preventive service: after you meet the annual Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for the DRE and the doctor's related services, plus a separate hospital visit copayment if it's done in a hospital outpatient setting. These cost rules apply to screening only; a PSA test ordered to investigate symptoms or follow a diagnosed cancer is diagnostic and isn't covered at $0 under the screening benefit. The statutory basis is Social Security Act §1861(oo) (42 U.S.C. 1395x(oo)) and 42 CFR 410.39.4

This is a common point of confusion, and it is worth confirming with your provider which test is being ordered before your visit.

Whether to screen at all

Prostate screening is a genuine decision, not an automatic one. The U.S. Preventive Services Task Force (USPSTF) gives PSA-based screening a Grade C recommendation for men aged 55 to 69 (an individual decision after discussing benefits and harms with a clinician) and a Grade D recommendation (recommends against) for men 70 and older; that is the May 2018 recommendation, which the USPSTF is now updating.4 Medicare covers the PSA regardless, but the clinical guidance is to talk it through with your doctor.

Lung cancer screening with low-dose CT

Medicare Part B covers annual lung cancer screening with low-dose CT (LDCT) under National Coverage Determination (NCD) 210.14. You qualify only if you meet all of these: age 50-77; asymptomatic; a tobacco history of at least 20 pack-years (an average of one pack a day for 20 years); a current smoker or someone who quit within the last 15 years; and an order from your provider.5

The required counseling visit

Before your first screening, you must have a counseling and shared decision-making (CSDM) visit, using decision aids that cover the benefits and harms of screening, follow-up testing, over-diagnosis, false-positive rates, and radiation exposure. The visit has to be documented in your medical record. Both the CSDM visit and the LDCT are $0 when the provider accepts assignment, because lung screening is covered under the additional preventive services provision at §1861(ddd) of the Social Security Act.5

A coverage gap to know about

Medicare and USPSTF do not line up perfectly on age. USPSTF recommends annual LDCT screening for adults 50 to 80, but Medicare's NCD 210.14 covers it only through age 77, so adults 78 to 80 meet the USPSTF recommendation yet fall outside Medicare's coverage age band.5

Worked example: Frank, age 62, Tifton

Frank has Original Medicare. He smoked one pack a day for 30 years and quit 14 years ago (inside the 15-year window) and has no symptoms, so he meets all the criteria.5 His doctor documents the shared-decision-making counseling visit ($0) and orders the LDCT ($0).5 If a future scan turns up a suspicious finding, the follow-up diagnostic CT and biopsy convert to diagnostic billing with cost-sharing, but the screening itself stays free.

The Welcome to Medicare visit and the Annual Wellness Visit

Cancer screenings are usually ordered during routine primary care, and two Medicare visits anchor that process. Both are $0 with the Part B deductible waived, and neither is a head-to-toe physical exam.1

The one-time Welcome to Medicare preventive visit (the Initial Preventive Physical Examination) is available in your first 12 months of Part B and includes education about the screenings you're due for. After that, the yearly Wellness visit (the Annual Wellness Visit) is available once every 12 months and is where your provider reviews your history and orders the cancer screenings you need.1 Skipping the Wellness visit is one of the easiest ways to miss screenings, so it is worth scheduling.

What "$0 cost-sharing" does and does not cover

The $0 applies to the screening test itself, delivered to someone without symptoms, when the provider accepts assignment.1 It does not carry over to what comes after an abnormal result:

• Diagnostic follow-up. A diagnostic mammogram, ultrasound, or biopsy after an abnormal screening carries 20% coinsurance after the Part B deductible ($283 in 2026).3 A polyp removed during a screening colonoscopy triggers the 15% coinsurance described above (deductible waived).1
• Specialist consultations. A referral to a specialist after an abnormal screening is a standard service with the usual 20% coinsurance after the deductible.8
• Treatment of diagnosed cancer. Once cancer is diagnosed, the $0 screening framework ends. Outpatient chemotherapy and radiation are covered under Part B at 20% after the $283 deductible; inpatient care runs through the Part A deductible ($1,736 per benefit period in 2026); and the Part D out-of-pocket cap on covered drugs is $2,100 in 2026.9

Cancer screening and Medicare Advantage in Georgia

Georgia is a high-Medicare-Advantage state: as of March 2026, CMS counted 2,024,284 people with Medicare in Georgia, and 1,132,173 of them (more than half) were enrolled in Medicare Advantage and other health plans.10 Every Medicare-eligible Georgian has access to at least one $0-premium plan for 2026.10 So how MA plans handle screening matters to most Georgians on Medicare.

Medicare Advantage plans must cover all the services Original Medicare Part A and Part B cover, including these screenings, but a few practical differences apply:11

• Networks. In an HMO you generally must use the plan's network, and non-emergency care outside it without authorization can leave you paying the full cost; a PPO lets you go out of network but usually at a higher price. Confirm the screening facility is in-network before scheduling.11
• Prior authorization and referrals. An MA plan may require prior authorization before it covers certain services, and many HMOs require a referral from your primary care doctor for specialist care. Confirm with your plan.11
• Out-of-pocket cap. MA plans cap your in-network out-of-pocket spending; the federal ceiling is $9,250 in-network for 2026, and many plans set a lower limit. That cap can protect you if a screening leads to diagnostic workup and treatment.8

For dual-eligible Georgians (Medicare plus full Georgia Medicaid), a Dual Eligible Special Needs Plan (D-SNP) is the Medicare Advantage plan type built for people with both coverages. Which D-SNPs you can join depends on your county, and the Georgia Department of Community Health placed a moratorium on contracting with any new D-SNPs starting August 1, 2025.12

Original Medicare with Medigap

Many Georgia beneficiaries pair Original Medicare with a Medigap (Medicare Supplement) policy. Medigap does not change the $0 screening benefit, but it can pay the coinsurance that hits when a screening becomes diagnostic (the 20% on a diagnostic mammogram or biopsy, or the 15% on a polypectomy). What it pays depends on the plan letter: Plan G, for example, pays Part B coinsurance in full but leaves you the Part B deductible ($283 in 2026).7 The trade-off is the monthly Medigap premium on top of the Part B premium, and that premium varies by policy, where you live, and other factors.8

Where Georgia beneficiaries get help with Medicare cancer screenings

For lung screening specifically, Medicare requires the scan to be done at a radiology facility that uses a standardized system for identifying and reporting lung nodules, and read by a radiologist who is board-certified or board-eligible with the American Board of Radiology, so confirm that before you book.5

For women who are uninsured or underinsured and not yet on Medicare, the Georgia Breast and Cervical Cancer Program (BCCP), administered by the Georgia Department of Public Health (DPH), provides breast and cervical cancer screening, diagnostic services, and referral to treatment for uninsured and underinsured Georgia women who meet its income criteria. Its breast services cover ages 40 to 64, and its cervical services cover women 65 and older only if they aren't enrolled in Medicare Part B, so once you have Medicare, the $0 screening benefit is your route. To check eligibility, call your local county public health department.13

For free, unbiased help understanding your Medicare coverage, including comparing plans and lowering out-of-pocket costs, GeorgiaCares, Georgia's State Health Insurance Assistance Program run through the Division of Aging Services, offers certified counselors at no cost.14

Common questions

Learn More

Find personalized help navigating Georgia Medicare cancer screenings at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.