Does Medicare Cover MRI?
- Diagnostic testing, such as MRI, is essential to preventative health care and can help ensure that a health issue does not worsen without intervention.
The various parts of the U.S. government's Medicare program help individuals age 65 and older, as well as those with disabilities, bear the financial cost of medical services. Each of the different parts covers various components of health care, and which section of Medicare covers an MRI depends on the surrounding circumstances.
What Is an MRI?
An MRI, or magnetic resonance imaging, is a diagnostic technique in the form of a tube-like machine that uses radio waves to capture images of the internal components of the body. It combines the radio waves with a magnetic field to complete this process.
One of the reasons this is such an effective form of diagnostic testing is because the machine can capture 3D images of the internal organs and processes. This can alert medical professionals to any potential illnesses or diseases.
Does Medicare Cover MRIs?
Medicare does cover MRIa in specific circumstances. General criteria associated with approval for an MRI includes:
- The scan must have been prescribed by a licensed physician as part of a treatment protocol for a health-related issue.
- All providers involved (the prescribing physician and MRI facility/provider) must be in the Medicare network.
Part A coverage extends to those receiving the scan as part of inpatient services in a hospital or medical facility. Part B coverage extends to those receiving an MRI as part of outpatient treatment or diagnostic protocols.
Medicare pays 80% of the cost for an MRI as long as it is an authorized scan. This coverage falls under Part B, which means that beneficiaries will have to pay the deductible on their specific plan. However, those with a Medicare Advantage plan or Medigap coverage may have fluctuating costs, including more coverage than that offered in Part B, depending on the reason for the scan and plan type. Beneficiaries are still responsible for the other 20%, which is why knowing type, cost and what other coverage might supplement out-of-pocket expenses is essential.
Additional Cost Factors
MRI costs through Medicare may vary depending on the area of the body being scanned and the type of MRI. For instance, an Extremity MRI is one that looks for specific issues in the extremities of the body. This might be less expensive than one necessary to scan the brain.
The type and location of the MRI facility is also a factor. A standalone MRI facility might be more cost effective when considering out-of-pocket expenses than a hospital. Additionally, costs might include any sedative necessary for more in-depth MRI testing, specialized MRI reading and the use of dye or contrast.