Other than skin cancers, breast cancer is the most common form of cancer among women in the U.S. Women who are middle-aged and older are most prone to the condition. To aid in the early detection of breast cancer, women who are aged 40 or older should receive a mammogram each year. Many women in this age group are Medicare beneficiaries and may be concerned about Medicare’s mammogram coverage.
Does Medicare Pay for Mammograms?
If you are a Medicare beneficiary who is 40 and older, Medicare generally covers the cost of a mammogram every 12 months. It is important to understand all areas of coverage:
- If you have a need for additional mammogram testing, Medicare may pay depending on your coverage, age, and medically necessity as approved by a doctor.
- Medicare Part B is responsible for mammograms that a doctor’s office, outpatient facility, or outpatient radiology provider performs.
- Keep in mind that the cost of a mammogram may vary based on where the service is provided and whether the mammogram is diagnostic or routine. Nevertheless, if a provider accepts Medicare assignment, they cannot charge you more than the Medicare allowable charge for the service.
Is There an Out-Of-Pocket Expense for a Screening Mammogram?
If your doctor accepts Medicare assignment, you pay nothing out-of-pocket for your annual screening mammogram. However, when you receive a diagnostic mammogram, you are responsible for 20% of the approved cost of the test.
Are All Diagnostic Mammograms Covered by Medicare?
Sometimes, a screening mammogram may indicate an abnormality, such as an area of unusually dense breast tissue. As a result, your medical provider may request a diagnostic mammogram.
If your doctor requires a diagnostic mammogram:
- Medicare Part B pays for the service. Medicare covers 80% of the allowable charge for a diagnostic mammogram, and you are responsible for the remaining 20%.
- The 20% is paid out-of-pocket unless you are covered by supplemental insurance.
Will Medicare Cover a 3D Mammogram?
Some providers prescribe 3D mammograms for their patients. Unlike the images from a 2D mammogram, which only display the side and front views of the breast, 3D mammograms show multiple images. As a result, they are better able to detect cancer.
Medicare does pay for 3D mammograms. However, the tests are more expensive than their 2D counterparts. Consequently, if you receive a diagnostic 3D mammogram, the 20% coinsurance may be a bit higher.
Does Medicare Pay for MRIs of the Breasts?
Medicare offers coverage for breast MRIs when the tests are medically necessary. After Medicare Part B pays its portion, you are responsible for the remaining 20% unless you have a supplement.
Does Medicare Stop Paying for Mammograms When You Reach a Certain Age?
Medicare continues to cover mammograms as you age. There is no age-related cutoff. You will remain eligible for screening and diagnostic mammograms if you have Medicare.
When It Comes to Medicare and Mammograms, Is Additional Coverage Available for Out-of-pocket Mammogram Expenses?
Although Medicare covers diagnostic mammograms, ultrasounds, and MRIs, the out-of-pocket costs can become expensive—especially if you receive multiple tests in a brief period. Supplemental insurance can help by paying for the expenses that are left after Medicare pays.
Medicare Supplement Insurance is available at various costs with different coverage options. You can choose the option that best fits your budget and medical needs.
- How Common is Breast Cancer?, Medicare.
- What is a Mammogram?, CDC.