How Often Is a Mammogram Covered Under Medicare?
- Medicare will cover a mammogram every year for women aged 40 and older. Medicare covers screening mammograms and diagnostic mammograms slightly differently, so it helps to know how your coverage works before going to your doctor.
The American Cancer Society advises women over the age of 55 to undergo a mammogram at least every two years, if not annually. Early detection is one of the most important factors in helping protect women from breast cancer.
Medicare typically covers a mammogram every year for women once they reach age 40. How Medicare covers mammograms depends on whether it is a screening mammogram or a diagnostic mammogram. Read more to learn exactly how Medicare mammogram coverage works and the costs involved.
Does Medicare Cover Diagnostic Mammograms?
Original Medicare (the name for Medicare Part A and Part B) cover the costs of three types of mammograms under Medicare Part B.
- Medicare covers one screening mammogram every year for women age 40 and older.
- Medicare covers one baseline mammogram for women between the ages of 35 and 39.
- If considered medically necessary, Medicare covers diagnostic mammograms more frequently than once per year.
Mammograms may be deemed medically necessary if the patient has a history of breast cancer, has signs or symptoms that may indicate breast cancer or if a doctor otherwise believes that a mammogram is necessary.
How Much Is a Mammogram With Medicare?
For screening mammograms, women on Medicare will pay nothing out of pocket, as long as the doctor or health care provider administering the mammogram accepts Medicare assignment.
For diagnostic mammograms, you will typically pay a Medicare Part B coinsurance charge equal to 20% of the Medicare-approved amount for the test after you meet your annual Part B deductible.
While men can and do develop breast cancer, Medicare does not provide any coverage of screening mammograms for men. Medicare will cover a diagnostic mammogram for a man if deemed medically necessary.
Does Medicare Advantage Cover Mammograms?
Medicare Advantage (also called Medicare Part C) plans are required by law to provide all of the same benefits found in Medicare Part A and Part B. This means every Medicare Advantage plan covers mammograms and breast cancer screenings in the same way as described above.
A screening mammograms (yearly mammogram) is covered in full when performed by an in-network doctor. Diagnostic mammograms are subject to deductibles and coinsurance or copayments. Depending on the type of Medicare Advantage plan you have (such as an HMO or PPO plan), you will typically pay less if you visit a doctor who is in your plan’s provider network.
Be sure to check with your Medicare Advantage insurance plan carrier to make sure that your doctor accepts your Medicare plan before getting a mammogram.
Are Mammograms Covered by Medicare Supplement Plans?
A Medicare Supplement Insurance plan, also called a Medigap plan, won’t cover a mammogram, but it can help pay for some of the out-of-pocket Medicare costs you might face when you get a mammogram.
Medigap plans help cover Medicare deductibles, coinsurance, copayments and other out-of-pocket costs. Certain Medigap plans can provide full coverage of the Medicare Part B coinsurance that is required for diagnostic mammograms.
Medigap plans can also cover Part B excess charges, which may be incurred if you receive a mammogram from a health care provider who does not accept Medicare assignment.
What Happens During a Screening vs. Diagnostic Mammogram?
A screening mammogram generally consists of conducting two or more X-ray images of each breast. The X-rays can reveal tumors that are undetectable by touch and calcium deposits that can indicate cancer.
Diagnostic mammograms take a greater number of images using more angles of the breast. Diagnostic mammograms are used to monitor and compare changes in the breast that may be first revealed by a screening mammogram.
What Are the Different Types of Mammograms?
There are two main types of mammograms.
- A film screen mammogram is like a traditional X-ray and records an image on a sheet of film.
- Digital mammograms publish the image to a computer where it can be viewed with 2D and even 3D imaging technology.
Both types of mammograms are covered by Medicare.
If you have any questions about Medicare’s coverage of mammograms such as whether or not you are eligible for a diagnostic mammogram or if your doctor accepts Medicare, call 1-800-MEDICARE (1-800-633-4227).
If you are enrolled in a Medicare Advantage plan, you may contact your plan directly.