Women's Health Coverage Under Medicare: What the State Data Reveals

Women represent the majority of Medicare's enrolled population — and yet the coverage landscape for women's specific health needs remains uneven, inconsistent, and in some states, genuinely inadequate. If you're a woman over 65 navigating Medicare Advantage options, understanding how your state stacks up on women's health metrics isn't just academic. It directly affects which plan you should choose, what screenings you can access without a copay, and whether your chronic conditions will be managed proactively or reactively.

According to CMS.gov data, there were approximately 7,400 Medicare Advantage plans available nationwide in 2026, spanning HMO, PPO, PFFS, and SNP plan types. But the number of plans available in your county — and what those plans actually cover for women's preventive care — varies enormously. A woman in Miami-Dade County, Florida may have access to 80 or more plan options. A woman in rural Montana or Wyoming may have fewer than five. That disparity in choice is the first layer of the women's health coverage problem under Medicare.

Let's start with preventive screenings, because this is where the dollar impact is most immediate. Under Original Medicare (Part B), women are entitled to an annual mammogram with no cost-sharing, a Pap smear and pelvic exam every 24 months (or annually if you're at high risk), a bone density measurement every 24 months for those at risk for osteoporosis, and colorectal cancer screenings on a defined schedule. These are guaranteed benefits. The problem arises when women enroll in Medicare Advantage plans, which must cover at least what Original Medicare covers — but the way they structure cost-sharing, network restrictions, and prior authorization requirements can create real barriers. A mammogram that costs you nothing under Part B might require a $30 specialist copay under an HMO if your primary care physician's referral process is delayed or if the imaging center is out-of-network.

State-level data from KFF's Women's Health State Profiles reveals stark differences in cancer screening rates by geography and race. Breast cancer incidence and cervical cancer rates vary significantly by state and by racial and ethnic group. Black women, for example, face higher breast cancer mortality rates than white women despite similar or lower incidence rates — a disparity driven in part by later-stage diagnosis, which is itself tied to gaps in screening access and follow-through. For Medicare beneficiaries, this means that living in a state with lower screening utilization rates isn't just a public health statistic — it's a signal that the local healthcare infrastructure, including the Medicare Advantage plans operating in that market, may not be adequately supporting preventive care.

Chronic conditions are the other major dimension of women's health under Medicare. Women over 65 are disproportionately affected by osteoporosis, autoimmune diseases, depression, anxiety, and Alzheimer's disease. According to the Alzheimer's Association, nearly two-thirds of Americans with Alzheimer's are women. Depression affects roughly 16% of women over 65, yet mental health benefits under Medicare Advantage plans remain highly variable. Some plans offer $0 copays for mental health visits; others charge $40 to $50 per session after a deductible. When evaluating plans during the Annual Enrollment Period — which runs October 15 through December 7 each year — women with depression, anxiety, or cognitive concerns should specifically compare the mental health cost-sharing structure, not just the premium.

Osteoporosis management is another area where plan design matters enormously for women. Bone density testing is covered under Part B, but the medications used to treat osteoporosis — bisphosphonates like alendronate, injectable options like denosumab (Prolia), and newer agents like romosozumab — fall under Part D drug coverage, and formulary placement varies dramatically. Prolia, for instance, is a biologic administered by injection in a clinical setting, which means it may fall under Part B medical coverage rather than Part D in some plans, but under Part D in others. That distinction can mean the difference between a $0 copay and a $200 or more cost-share per dose. Women currently on osteoporosis medications should run their specific drugs through the Medicare Plan Finder tool at Medicare.gov before selecting or switching plans.

Data Snapshot: According to CMS.gov data from the 2026 Medicare Advantage landscape file, the average Medicare Advantage plan star rating nationally sits at approximately 3.9 out of 5 stars, with roughly 51% of plans earning 4 stars or higher. Plans rated 4 stars or above are eligible for quality bonus payments, which insurers can reinvest into supplemental benefits — including expanded women's health services like additional gynecological visits, fitness benefits, and over-the-counter allowances that can offset the cost of health monitoring supplies. Choosing a 4-star or higher plan isn't just about quality bragging rights; it often translates into tangible extra benefits that lower-rated plans don't offer.

Sexual health is a topic that doesn't get nearly enough attention in Medicare coverage discussions, but it matters for women over 65. STI rates among adults 65 and older have been rising for over a decade, according to CDC surveillance data. Medicare Part B covers STI screenings for beneficiaries at increased risk, including HIV screening once every 12 months. Hepatitis B and hepatitis C screenings are also covered. However, many women don't know these benefits exist or don't feel comfortable raising the topic with their primary care physician. Medicare Advantage plans with strong care coordination and annual wellness visit structures — where a nurse or care coordinator proactively reviews your full health profile — are more likely to surface these screenings as part of routine care.

Maternal health data, while primarily relevant to younger women, has an indirect but important connection to Medicare beneficiaries: it shapes the long-term health trajectory of women who are now in their 60s and 70s. Women who experienced preeclampsia, gestational diabetes, or preterm delivery decades ago face elevated lifetime risks for cardiovascular disease, Type 2 diabetes, and kidney disease. If you had any of these pregnancy complications, you may be at higher risk for conditions that Medicare Advantage plans should be actively managing. When you complete your Annual Wellness Visit — which is free under Medicare and available once per year — bring up your full obstetric history. A good primary care physician will factor it into your cardiovascular and metabolic risk assessment.

Health insurance coverage rates for women vary significantly by state, and those variations affect how well Medicare beneficiaries are served even after they age into Medicare. States that expanded Medicaid under the ACA tend to have stronger healthcare infrastructure, more robust provider networks, and higher rates of preventive care utilization — all of which benefit Medicare Advantage enrollees in those states because the underlying system is better resourced. States without Medicaid expansion often have thinner provider networks, higher rates of uninsured working-age adults (who become Medicare beneficiaries with delayed diagnoses), and fewer safety-net facilities that accept Medicare Advantage plans.

If you're approaching the Annual Enrollment Period and want to evaluate your Medicare Advantage plan through a women's health lens, here's a practical checklist. First, confirm that your plan covers your annual mammogram, Pap smear, and bone density scan with zero cost-sharing — this is required by law, but verify the network requirements. Second, check the formulary for any osteoporosis, hormone-related, or mental health medications you take, and confirm their tier placement and cost-sharing. Third, look at the plan's star rating on Medicare.gov — aim for 4 stars or higher. Fourth, check whether the plan offers a care coordination or chronic disease management program, which can be especially valuable for women managing multiple conditions. Fifth, if you see a gynecologist regularly, confirm that specialist is in-network before you enroll.

The Open Enrollment Period (OEP), which runs January 1 through March 31 each year, gives Medicare Advantage enrollees one additional opportunity to switch plans if they realize after January 1 that their current plan isn't meeting their needs. You can switch to a different Medicare Advantage plan or return to Original Medicare (and then add a Medigap policy, subject to medical underwriting in most states). This is not a widely advertised window, but it's a real safety valve for women who discover mid-winter that their new plan has inadequate coverage for a medication or specialist they depend on.

For women who are considering Medigap (Medicare Supplement) coverage instead of Medicare Advantage, the coverage structure is more standardized but the premiums vary significantly by age, gender, and state. Medigap Plan G is currently the most comprehensive option available to new Medicare enrollees (Plan F was discontinued for new enrollees after January 1, 2020). Plan G covers the Part A deductible ($1,676 in 2026), skilled nursing facility coinsurance, and foreign travel emergency care, among other benefits. Average monthly premiums for Plan G range from roughly $100 to $200 or more depending on your state, age, and the insurer — women in some states pay lower premiums than men due to gender-based pricing, while other states prohibit gender rating entirely. Checking with your State Insurance Commissioner's office will clarify the pricing rules in your state.

Ultimately, the data on women's health across states tells a consistent story: geography, race, income, and plan design all interact to shape whether a woman over 65 gets the preventive care, chronic disease management, and specialist access she needs. Medicare gives you the framework; the plan you choose fills in the details. Use the Annual Enrollment Period — October 15 through December 7 — to review your plan with fresh eyes, specifically through the lens of your own health history and the conditions most likely to affect women at your stage of life. The right plan may not be the cheapest one. It's the one that covers what you actually need, with the providers you actually trust.