Medicare pays for an annual mammogram screening for beneficiaries ages 40 and up. Medicare covers necessary diagnostic mammograms and other types of testing.
But, you may have to pay part of the cost. For example, a diagnostic test will cost you 20% after you meet the deductible. Further, most of the time, preventive services Medicare covers in full.
Below we look into the different testing Medicare covers and the costs you might incur.
Does Medicare Pay for Mammograms
Part B covers mammograms at a doctor’s office, outpatient imaging center, or other outpatient facilities. Costs will be different for screening mammograms than for diagnostic mammograms.
If you’re under age 65 and on Medicare, Medicare will pay for one baseline mammogram when you’re between 35 and 39 years old. Once you’re 40, Medicare pays for a screening mammogram every year.
When the doctor accepts assignment, you pay nothing for the screening. If the test is 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.
Tip: Medicare Supplement plans cover the 20% that Medicare would make you pay.
Does Medicare Pay for Screening Mammograms
Medicare pays for a routine screening mammogram every year, starting at age 40. If you do see an out of network provider, it could cost you several hundred dollars.
Tip: When you schedule an appointment, ask the facility if they accept your coverage.
Does Medicare Cover Diagnostic Mammograms
If a screening shows abnormalities, your doctor may order a diagnostic mammogram. Part B covers diagnostic mammograms, but you’ll pay 20% of the cost unless you have a supplement.
When a screening shows breast abnormalities or a high breast density, your doctor may recommend follow-up testing.
Testing might include a diagnostic mammogram, a breast ultrasound, or a breast MRI. Medicare pays for as many diagnostic mammograms that a doctor requires.
Tip: When Medicare approves a service, the Medigap plan must also approve.
Does Medicare Pay for 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 covers 3D mammograms in the same way as 2D mammograms. But, a 3D image is more expensive than a standard 2D mammogram.
If your mammogram is for diagnostic purposes, your out of pocket costs may be higher with a 3D test.
Tip: Medigap plans can give you lower out of pocket costs.
Medicare Breast Cancer Screening
In addition to mammograms, Part B covers a well-woman exam as a preventive service every two years.
The exam includes a manual breast exam to detect lumps or other abnormalities that indicate breast cancer.
Tip: The exam has 100% Medicare coverage, as long as your doctor accepts assignment.
Medicare and Mammogram FAQ’s
Does Medicare Cover Mammograms After Age 65?
Medicare does cover mammograms for women aged 65-69. Annual screening mammograms have 100% coverage. Medicare pays 80% of the cost of 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.
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 percent of breast cancer diagnoses occur in women aged 75-84.
The American Cancer Society recommends women in their late 70s have breast cancer screenings.
The U.S. Preventive Services Task Force says there’s not enough evidence to make a recommendation about mammograms for women 75 and older.
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. If your age and health don’t make you a candidate for breast cancer treatments, a mammogram may have little value.
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.
How Often Does Medicare Pay for Mammograms?
Medicare will pay for one baseline mammogram for women between the ages of 35 and 39 who are on Medicare. It will pay for a screening mammogram every year for women aged 40 and up.
Diagnostic mammograms are covered whenever they’re necessary.
Does Medicare Cover Breast Ultrasound?
Part B covers breast ultrasound as a diagnostic procedure if it’s necessary. Medicare will pay 80 percent of the cost, and you’ll be responsible for the other 20 percent.
Does Medicare cover ultrasound for dense breast tissue
Dense breasts have fibrous tissue that can make it hard to detect abnormalities in a mammogram. An ultrasound may provide extra information.
Part B will pay 80 percent of the cost of a diagnostic ultrasound if it is necessary.
Does Medicare Cover 3D Breast Imaging?
In addition to 3D mammograms, Medicare covers 3D breast MRIs if necessary. You can expect to pay 20% of the cost of an MRI if you don’t have other insurance.
Extra Help with Your Medicare Costs
If you need diagnostic mammograms, MRIs, or ultrasounds, the costs can add up. Medicare supplements can help by covering the expenses Medicare doesn’t pay.
There are plenty of options through top companies. Whether you want Advantage or 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!
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