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Does Medicare Cover Mammograms

Original Medicare pays for an annual mammogram screening for beneficiaries ages 40 and up. Medicare covers necessary diagnostic mammograms and other types of testing based on diagnosis and medical necessity. Based on the type of mammogram you receive, cost and coverage may vary. So, it’s important to understand if your test is diagnostic or routine to best understand your costs. Below we look into the different testing Medicare covers, costs you might incur, and how often Medicare will cover a mammogram.

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How Often Does Medicare Pay for Mammograms?

If you’re under age 65 and enrolled in Original Medicare coverage, Medicare will pay for one baseline mammogram when you’re between 35 and 39 years old. Once you turn age 40, Medicare pays for a screening mammogram every year. This is considered a preventive service. Thus, if your provider accepts Medicare Assignment, you will not pay for this annual test. It will be 100% covered by your coverage.

If the mammogram is deemed diagnostic, you’ll pay 20% of the costs. The average cost of a diagnostic Mammogram with Medicare is around $170. But, depending on your area and if you have extra insurance, your costs could be different. Keep in mind if your screening mammogram detects a lump, it will automatically be billed as a diagnostic mammogram, regardless of how the test was initially labeled.

learn how to reduce your risk of breast cancer.

Does Medicare Cover 3D Mammograms?

A 3D mammogram creates multiple breast images, whereas a standard 2D mammogram shows only front and side views. Studies show that a 3D mammogram or digital breast tomosynthesis is more likely than a 2D image to detect breast cancer.

Medicare began covering 3D mammograms in 2015 as a more accurate way to detect breast cancer. However, if you receive a 3D mammogram as a diagnostic test, your out-of-pocket costs may be higher than with a traditional 2D mammogram.

However, if you are enrolled in a Medicare Supplement plan, those additional costs may be covered by your plan. To best determine your costs, it is important to know which type of mammogram your provider will be performing.

Does Medicare Cover 3D Breast Imaging?

In addition to 3D mammograms, Medicare covers 3D breast MRIs if medically necessary. These tests typically come after a diagnostic or inconclusive mammogram. You can expect to pay 20% of the cost of an MRI if you don’t have supplemental insurance.

Medicare Coverage for Screening vs. Diagnostic Mammograms

Original Medicare covers both screening and diagnostic mammograms, but there are some differences in coverage.

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Screening mammograms are covered as a preventive service for eligible Medicare beneficiaries. Medicare Part B covers a screening mammogram once every 12 months for women who are 40 years of age or older. Screening mammograms are used to detect breast cancer in women who have no signs or symptoms of the disease.

Diagnostic mammograms, on the other hand, are used when there is a suspicion of breast cancer, such as when a lump is detected or other symptoms are present. Medicare covers diagnostic mammograms when they are ordered by a healthcare provider as medically necessary. Diagnostic mammograms may be covered more frequently than once every 12 months, depending on the individual’s medical needs.

It’s important to note that while Medicare covers both screening and diagnostic mammograms, there may be differences in cost sharing for the beneficiary. For example, there may be a copayment or coinsurance for a diagnostic mammogram, while a screening mammogram may be covered at no cost to the beneficiary. It’s a good idea to check with your healthcare provider and Medicare plan to confirm coverage and any potential out-of-pocket costs before scheduling a mammogram.

Does Medicare Cover Breast Ultrasound?

Medicare covers breast ultrasounds under certain circumstances. Medicare Part B covers breast ultrasound when it is ordered by a healthcare provider as medically necessary. This may include cases where a mammogram has shown an abnormality in the breast or when a woman has dense breast tissue that may make it difficult to detect abnormalities with a mammogram alone.

In addition, Medicare may cover breast ultrasounds for women who are at high risk for breast cancer due to family history, genetic mutations, or other factors. In these cases, the ultrasound may be used as a supplemental screening tool to detect early signs of breast cancer.

It’s important to note that while Medicare covers breast ultrasound, there may be additional costs, such as copayments or deductibles.

Does Medicare Cover Mammograms After Age 65?

Medicare does cover mammograms for women aged 65-69. Annual screening mammograms are covered at 100%, while Medicare pays 80% of the cost for diagnostic mammograms.

Mammograms remain an important cancer detection tool as you age. Twenty-five percent of breast cancer diagnoses involve women aged 65-74. A U.S. Preventive Service task force found that women aged 60-69 who had regular mammograms had a 33 percent lower risk of dying from breast cancer. The task force and other organizations recommend that women in their 60s have screening mammograms every other year. The American Cancer Society recommends them every year.

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FAQs

Does Medicare pay for mammograms after age 70?
Medicare also pays for annual mammograms for women who are 70 and older at the same rates it pays for women aged 65-69. There have been few studies on the effectiveness of screening mammograms in women in their 70s. Several major health organizations recommend mammograms every year or every other year for women aged 70-74.
Does Medicare pay for mammograms after age 75?
Part B continues to cover screening and diagnostic mammograms for women in their late 70s. Medicare pays the full cost of testing annually and 80% of the cost of diagnostic mammograms. About 14% of breast cancer diagnoses occur in women aged 75-84. The American Cancer Society recommends women in their late 70s have breast cancer screenings.
Does Medicare cover mammograms after age 80?
Medicare continues to cover yearly screening mammograms for women in their early 80s. But, as you age, it’s a good idea to talk to your doctor about the risks and benefits of mammograms. Risks of mammograms include false positives and unnecessary treatment. Most major health organizations do recommend that you continue to have regular mammograms as long as you are in good health.
Will Medicare pay for a mammogram at age 85 or 90?
When it comes to mammogram coverage, Medicare doesn’t discriminate by age. Women in their late 80s and 90s still have Medicare coverage for both screening and diagnostic mammograms. An estimated six percent of breast cancers are diagnosed in women aged 85 and up.
At what age does medicare stop paying for screening mammograms?
There is no cutoff age for Mammograms covered by Medicare. As long as you’re enrolled, Medicare will pay for your annual mammogram screening.

How to Get Extra Help with Your Mammogram Costs with Medicare

If you need diagnostic mammograms, MRIs, or ultrasounds, the costs can add up. Medicare Supplements can help by covering the expenses Medicare does not pay. There are plenty of options through top companies. When you want to compare Medicare Advantage vs. Medicare Supplement coverage, our agents can help you.

Don’t waste time calling a bunch of companies, call our agents to talk with one person that can get you a quote with all the top carriers. Our agents are Medicare experts. Your agent will ask you a few questions to better understand what you want and need in your policy. Then, your agent will explain a few options for you.

Once you decide the best plan for your needs, your agent will walk you through the application process over the phone. To get advice from a Medicare expert, call the number above now! Also, you can fill out an online rate form and get one step closer to your ideal coverage.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

32 thoughts on "Does Medicare Cover Mammograms"

  1. I have dense breasts and have symptoms of pain in left breast and feeling lumps and am due for my mammogram the end of this month. Will Medicare pay for a MRI instead since I’m having symptoms and have dense breasts? I also have family history of breast cancer but it’s paternal and a sibling with lung cancer.

    1. Hi Karen. Yes, Medicare Part B will cover 80% of the cost of a diagnostic MRI if ordered by your doctor and done at a facility that accepts Medicare.

  2. I made arrangements for my annual physical, lab work, and mammogram all at the same time. This was just easier for me and my commitments. My supplemental plan covers them one a year. And they go by calendar year. Well, I was 12 days before the one year date for Medicare guidelines….which I only learned about after I received a billing of $668 from my provider. What can I do resolve the goof up in coverage denial?

    1. Hi Diane, you can always submit an appeal form through Medicare for repayment. You can contact your State Health Insurance Assistance Program (SHIP) for help filing an appeal.

  3. My doctor has written an order for a breast MRI because I’m high risk and mammograms are too painful for me. Will Medicare pay for that? I’m 66 with Medicare and BCBS as a supplemental.

    1. Mary, Mammograms are covered under Medicare part B. Part A covers hospital inpatient care, skilled nursing, and home healthcare.

  4. In January I had a screening mammogram which was normal. Recently I felt a lump and a diagnostic mammogram and ultrasound were ordered and performed 7/21. If all is well, when would I be eligible for my screening mammogram in 2022. Can’t find this information on line. Would it be in July of next year? Thank you

    1. Hello! Medicare will cover a mammogram once every year. So your next mammogram would be in July of 2022.

      1. If I am new to Medicare, will my screening mammogram be covered (1st mammogram since on Medicare) even if it is less than 12 months from my prior mammogram (when I was on private insurance). I want to get on a Jan/Feb schedule for ALL my routine “well check or preventive care” appointments. My last mammogram (private insurance) was in May 2020 and I want to schedule next one (Medicare) in 1Q21

      2. Hi Carol, if you mean 2021/2022, you should be fine to have your first mammogram on Medicare whenever, as long as your coverage is effective.

    1. Hi Dawn! If you have Original Medicare, no, you do not need prior authorization for a routine mammogram screening. However, if you have a Medicare Advantage plan, you might. It depends on what the carrier and what your summary of benefits says.

  5. Does Medicare cover the cost of a breast ultrasound? The radiologist determined I have dense breasts and recommends an ultrasound. I cannot find anything online other than Medicare will pay 80% if “it is necessary.” What “is necessary”? I need to know if Medicare covers the cost of this.

    1. Hi Vickie! Thank you for your question. Yes, you have to wait a full 365 days unless your doctor deems it medically necessary to do it more than once per year.

  6. Will medicare pay for both breast ultrasounds every year if you have dense fibrocystic breasts? I have a new suspicious area in one breast. The Radiologist wants ultrasounds on both breast.

    1. Hi Jeannine! As long as your doctor says the ultrasounds are medically necessary, then Medicare will cover them.

  7. I am 70 year old and received my annual mammogram under Medicare. Today just got a bill from the radiologist for $403 denied by insurance for a mammogram. Only thing is the bill is made out as though my husband is the one that got the mammogram. Who is at fault. We spoke to the hospital billing dept and they say the bill was sent to Medicare in my name. What is are recourse?

    1. Hi, Sherry! They can say it was billed in your name all they want, but if you have a bill from Medicare showing otherwise, they need to see a copy of it. I would send a copy of the bill over to the hospital billing department to show them it’s not in your name. They will need to contact Medicare to have it corrected.

  8. Replying to my other comment speaking to Medicare so many time I get all different answers the 1 agent from Medicare told me it would have to be the same month every year but any day within that month ? And you are saying something different so u saying it as to be the same month and same day each year or after the day of last routine mammogram

    1. I’m glad you asked! I was going to add to my original comment that more than likely as long as it’s within the same month, in your case August, regardless if it was a full 365 days in between, Medicare should still cover it. If you tried to get one in say July of the following year, Medicare may deny the claim in that case. I would say the agent you spoke to is correct. I do want to point out that you don’t have to get your mammogram the same month each year for Medicare to cover it. If you waited until say September, it will still be covered. I hope this helps!

  9. I’m using medicare for the first time and having my routine mammogram on August 29 2020 next year do I have to have my routine mammogram August 29 2021 or after or can I have my routine mammogram the same month which is August but any day in August ? I just don’t know what the 12 month is referring to

    1. Hi Maria! Great question. Medicare will cover an annual mammogram once every 12 months. So, you would want your next mammogram to be scheduled on August 29th, 2021, or after to avoid the claim being denied by Medicare.

    1. Hi Barbara! There is no cut off age for mammogram screenings covered by Medicare. Anyone with Medicare benefits that are over 40 years old is eligible for mammogram screenings once every 12 months. You can get these screenings more frequently than once a year if your doctor says it’s medically necessary.

  10. Is there any exception possible when one is going to be away for several months…e.g. Can I get a mammogram 7 days earlier than my actual 1 year date?

    1. Hi Sharon! This is a great question. Since your situation is very unique, I would call Medicare directly to see if they would allow you to get your yearly mammogram a few days early.

  11. What is unclear is what is meant by 12 months. Is it the month itself, is it to the day, or is it a year and a day?

    1. Hi Gail, great question! So it’s 12 months from the day of your last mammogram. So if you received your yearly mammogram on 10/8/19, you can receive your next one on 10/8/20 or after.

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