Does Medicare cover Mammograms?
This article was updated on: 09/12/2018
Mammograms are specialized x-rays of the breast tissue that detect breast cancer in women who may not have any other signs or symptoms of the disease according to the National Institute of Health (NIH) Library of Medicine. There are two types of mammograms done on the same machine:
- Screening mammogramsare done on a yearly basis for women, typically beginning at age 40, who have no unusual risk factors or symptoms of breast cancer.
- Diagnostic mammogramsare done when medically necessary because a doctor believes there is a high risk or other evidence to suggest the presence of breast cancer.
If your doctor orders a mammogram, Medicare generally covers all or a portion of the allowable costs associated with this test provided you meet the eligibility requirements.
How are mammograms performed?
Mammograms are usually performed at the diagnostic imaging department of a hospital or at a free-standing outpatient imaging clinic. When you have a mammogram, you will undress from the waist up and stand facing the mammogram machine. The mammography technician places your breast between two plastic plates, or paddles, and gently compresses the breast tissue to flatten it out. This is necessary to give a clearer picture of your breast tissue according to the National Institute of Health (NIH).
Some women feel some discomfort during the procedure, but it is rarely painful. The technician usually takes between two and three pictures, or views, of each breast. A radiologist will review the pictures and send a written report to your doctor, usually within just a few days.
According to the National Institute of Health (NIH) National Cancer Institute, diagnostic mammograms usually involve more focused views of a portion of one or both breasts. They are usually ordered when the radiologist discovers something questionable during a screening mammogram. Sometimes, a diagnostic mammogram is ordered when a patient has breast pain, nipple discharge, change in breast size or shape, or other symptoms of breast cancer, or is at high risk for developing breast cancer.
How does Medicare cover mammograms?
If you are a woman enrolled in Original Medicare (Part A and Part B) and you are age 40 or over, Part B will generally cover the allowable charges for one screening mammogram every 12 months so you have no charge. Your Part B deductible and coinsurance amounts may apply. Usually eleven full months must have elapsed since your last screening mammogram before Medicare will pay for another one.
If you are a Medicare beneficiary between the ages of 35 and 39, Part B will generally cover the allowable charges for one baseline mammogram prior to age 40.
If your doctor orders a diagnostic mammogram that is medically necessary for your care, Part B also covers 80% of the allowable charges after you’ve met your deductible.
Individuals who are enrolled in a Medicare Advantage plan (Medicare Part C) may also pay little or nothing out-of-pocket for mammograms. Some plans charge a small copayment or waive the deductible for screening tests like mammograms. Medicare Advantage plans must cover everything that Original Medicare covers (except for hospice care which is still covered by Part A), but they can and often do include additional benefits for members such as no-cost screening exams and even routine vision, hearing, and dental coverage. With a Medicare Advantage plan you must continue to pay your Part B premium.
Looking for more information about Medicare and mammograms?
If you have questions about Medicare coverage for routine health screenings like mammograms or other diagnostic tests, I am happy to help you understand your options. If you’d prefer a phone call or email with personalized information, click the corresponding link below. The Compare Plans button will show you information about plans you may be eligible for.