Whether you yourself has been affected by cancer or not, the odds are that you know someone who currently has or has had cancer in their life. Many Medicare beneficiaries need to know what Medicare coverage for Mammograms, and other cancer screenings, is available to them.
Medicare Coverage for Mammograms
If you carry Medicare Part B insurance, your benefits cover a portion, if not all, of the cost of a mammogram, as long as you’re a female age 40 or older. Part B benefits include a screening mammogram every 12 month, calendar year, which is covered at 100%.
This leaves no out of pocket costs for the Medicare beneficiary. Additionally, Part B benefits cover a diagnostic mammogram if your healthcare provider deems it as medically necessary. With diagnostic mammograms, Medicare will cover the diagnostic test at 80% of the Medicare-approved amount.
The remaining 20% coinsurance is left responsible for the Medicare beneficiary to pay. Keep in mind, this is after the Part B deductible has been met, which the beneficiary is also responsible to pay.
It is important to make sure the facility where your mammogram is being done is a participating provider with Medicare. Also, verify ahead of time that your physician is a participating provider with Medicare.
This is necessary, as should further diagnostic testing or medical treatment be needed after your mammogram study, you’ll want to have the Medicare Part B benefits available for additional healthcare costs.
Breast Cancer is the Second Most Command Cancer in America
Besides skin cancer, breast cancer is the second most common diagnosed cancer in America. Regardless of age, sex or religion, breast cancer is affecting both women and men across the world.
It has been estimated that as of 2018, approximately 2,550 men and approximately 330,080 women, will be affected in the United States alone. With breast cancer rates steadily inclining not just in our country, but worldwide, now more than ever, it’s imperative to take preventative action.
Mammograms are one of the most effective methods used when testing for and diagnosing breast cancer. In fact mammograms are the most effective way to detect early-stage breast cancer cases. So what exactly is a mammogram?
A mammogram is a diagnostic study used to detect breast cancer. The procedure itself uses a low-dose X-ray, useful in discovering tumors too tiny to detect through a self-breast exam.
The X-rays themselves, allow the radiologist to analyze the breast tissue for any skeptical looking areas. Additionally, these diagnostic images show microcalcifications (tiny clusters of calcium), spots or lumps (tiny masses), all of which can be caused by cancer, fatty cells or other conditions like fibrocystic breast disease (FBD).
While lumps are oftentimes benign (non-cancerous), rather than malignant (cancerous), the only way to be 100% certain is through further testing. Your healthcare provider may then go onto order additional diagnostic testing with either an ultrasound or MRI, or sometimes both. If any of these additional tests show an abnormality, it’s then likely that a breast biopsy is performed to detect if there are any abnormal cells present.
Different Types of Breast Cancer
People think of breast cancer and generalize it as just that, cancer that affects a woman’s breast(s). In all actuality, there are many forms of breast cancer. And not just that, breast cancer itself doesn’t just affect women as men can also develop the disease.
There are two main categories of breast cancer. Invasive breast cancer (infiltrating), which is when the cancerous cells affect not just the breast tissue, but also the bloodstream and lymph nodes.
If the bloodstream and lymph nodes are affected, the cancerous cells can then spread to other areas of the body. The second type of cancer is noninvasive breast cancer (in situ).
With noninvasive cancer, the cancerous cells remain in a specific area of the breast and do not spread to the surrounding tissues, lobules (the glands that make breast milk) or the breast ducts (the tubes that carry the milk supply to the nipple).
Types of Invasive Breast Cancer include:
- Invasive ductal carcinoma (IDC): IDC is the most common form of breast cancer and forms in the cells that line the milk duct and infiltrates through to the surrounding breast tissue. The affected cells can metastasize into other areas of the body.
- Invasive lobular carcinoma (ILC): this type of cancer starts in the lobules and can metastasize into other areas of the body, much like IDC cancer. This specific form of cancer is harder than IDC to detect through just a normal physical exam or mammogram.
In addition to IDC and ILC, there are some other types of sub-specialized cancers that fall into the invasive breast cancer category. They make up less than 5% of the breast cancers and are much less common.
In the two sub-types of invasive carcinomas, there are some cancers that fall into the category in which they have a better, overall prognosis than the common IDC cancer.
There is also another set of cancers that fall into the category of having a worse prognosis than the standard IDC cancer.
Special types of invasive breast cancer with a better prognosis include:
- Papillary carcinoma
- Tubular carcinoma
- Mucinous carcinoma
- Medullary carcinoma
- Low-grade adenosquamous carcinoma
- Adenoid cystic carcinoma
Special types of invasive breast cancer with a worse prognosis include:
- Micropapillary carcinoma
- Metaplastic carcinoma
- Mixed carcinoma (includes characteristics of both IDC and lobular cancer)
Types of noninvasive breast cancer, or in situ cancers, that stay in the area where the cancerous cells have formed and have not spread, include:
- Lobular neoplasia or lobular carcinoma in situ
- Intraductal carcinoma or ductal carcinoma in situ
There is also, the least common types of breast cancer which accounts for 1%-5% of all the cancers. These types of cancer include:
- Paget disease of the nipple
- Phyllodes tumor
- Inflammatory breast cancer (IBC)
Not all breast cancers are the same and depending on the type, location and in what stage the cancer is, will determine the best course of treatment recommended.
It is important to know the differences with breast cancer as well as all the various treatment options available to you and your specific cancer.
Talk to your healthcare provider and educate yourself so you can hopefully be a success story and end up in the category of statistics of people who beat the disease.
Who Should Get a Mammogram?
With cancer being a devastating disease, women and men alike need to take action. Heritage is a big factor but not the only factor. For those questioning when they should get a mammogram, here’s the important facts as outlined on an article online at BC Cancer Screening:
- Women after the age of 40, regardless of family history, should have yearly mammograms.
- Women aged 40-47 who have a close blood relative, such as a mother, sibling or child that’s ben diagnosed with breast cancer.
Mammogram eligibility doesn’t apply to everyone, here are some circumstances in which a mammogram isn’t recommended for you:
- If you’ve had a breast augmentation (breast implants). Talk to your medical provider for more information as to what to do.
- Pregnant or breastfeeding women cannot have radiation which is present during a mammogram. Additionally, there is the potential of a false negative or possible test result due to the pregnancy itself. Again, talk to your healthcare provider if you have concerns about getting a mammogram while pregnant.
- Women who have a previous history of breast cancer aren’t eligible, again, talk to a healthcare professional for more information.
- If you experience symptoms such as nipple discharge or feel lumps during a breast self-exam. You should follow up with your medical doctor as soon as you experience any of these symptoms or any other unusual symptoms in regards to your breasts that you might find concerning.
- Eligibility is only once a year, so if you’ve had the test within the last year you’re unable to have another procedure for 12 months.
Not just with breast cancer, but any cancer, early detection is key. For women, there, are a number of ways to detect breast cancer. According to the Cleveland clinic, breast self-exams (BSE’s) should be done monthly starting at the age of 20.
The importance of BSE’s is to feel for lumps or other changes in the breast. With ANY cancer, the earlier it’s detected, the better the prognosis.
Additional Help with Mammogram Costs
As with any diagnostic testing, not just mammograms, there is always cause for concern when it comes to out of pocket costs. Coupled with the fear of a potential breast cancer diagnosis and it’s enough to cause anyone stress.
When facing a potentially life-threatening illness like cancer, the last thing one should worry about is finances., Fear not, you have enough to worry about as it is! We can help get the extra 20% covered, and then some. Call or fill out the online form for more information on supplement plans.
With these individual plans, which can be tailored to your specific healthcare needs, you can get additional health insurance coverage. A Medicare Supplement Plan helps to save on costs associated with deductibles, coinsurance, copayments and other healthcare costs not covered by with Medicare benefits.
How often does Medicare cover mammograms?
One mammogram screening every 12 months will be fully covered for all women with Medicare over the age of 40. You can also get one baseline mammogram if you’re between the age of 35 and 39.
What age does Medicare cover mammograms?
As stated above, you can get a baseline mammogram as young as 35, but the normal screening is covered at age 40 and above.