Does Medicare Cover MRIs?
Original Medicare — Medicare Part A and Part B — covers 80 percent of an MRI’s cost if the health care providers involved accept Medicare. You’ll be responsible for 20 percent of the cost and your deductible. But having a Medigap policy or Medicare Advantage plan may reduce your out-of-pocket costs.
How Much Does Medicare Pay for an MRI?
Medicare will cover a portion of the cost of an MRI, or magnetic resonance imaging, scan in certain circumstances. But the MRI must meet three criteria.
- Your MRI is a necessary diagnostic test to determine your treatment for a medical condition.
- The MRI was ordered by a doctor who accepts Medicare.
- The MRI is performed in a hospital, ambulatory center or other facility that accepts Medicare
You’re out-of-pocket cost will vary depending on what type of Medicare coverage you have.
If you have Original Medicare, Medicare pays for 80 percent of the costs if you meet all criteria.
When a Doctor May Order an MRI
MRIs are widely used around the world to diagnose a wide range of medical issues. A doctor may order an MRI to diagnose or rule out a particular medical condition.
- Abdominal organ abnormalities or diseases
- Brain or spinal cord anomalies
- Breast cancer in women at high risk
- Heart conditions
- Joint injuries or abnormalities
- Liver diseases
- Tumors, cysts or other abnormalities
MRIs differ from X-rays and CT scans in that they do not use ionizing radiation. Instead, an MRI uses a combination of an electromagnet, radio waves and a computer working together to create a detailed, cross-sectional image of the inside of your body.
In 2015, there were 118 MRI exams performed in the United States for every 1,000 people, according to the Peterson-Kaiser Family Foundation Health System Tracker.
What Are Your Costs for an MRI Under Medicare?
If you have Original Medicare, you will be responsible for 20 percent of the MRI’s cost. Your Medicare Part B deductible — $203 in 2021 — will also apply. If you have a Medigap policy or a Medicare Advantage plan, you may have to pay less.
If you had Original Medicare in 2021, the average out-of-pocket expenses for an MRI of the brain came to $61 if done in an ambulatory surgery center and $99 if done in a hospital outpatient setting, according to Medicare.
The estimate included both facility and doctor fees, but if you have additional doctors you may have to pay more.
Medigap policies are sold by private insurance companies. They fill in the “gaps” that Original Medicare does not cover — such as copayments, coinsurance and deductibles.
Medicare Advantage plans are also sold by private insurers. They must cover everything Original Medicare covers, but they may offer additional benefits.
You should check with your Medicare Advantage or Medigap administrator to see what your specific plan covers.
Does Medicare Cover CT Scans and Other Diagnostic Scans?
Medicare classifies MRI scans as “diagnostic nonlaboratory tests” which are covered under Medicare Part B medical insurance.
These include a variety of tests that your doctor may order to diagnose or rule out a suspected illness or medical condition.
- CT Scans
- Computed tomography (CT) scans use X-rays and a computer to create a picture of your bones, organs and other tissue. CT scans can be used to examine just about any part of your body and can find fractures, tumors and complex medical conditions such as cancer or heart disease.
- Electrocardiograms — also called EKGs and ECGs — measure the electrical activity of your heartbeats. This electrical impulse causes your heart to squeeze and pump blood. An EKG can determine if you have a fast, slow or irregular heartbeat and can help a doctor tell if you have other heart problems.
- X-rays — also called radiography — are a form of radiation that can pass through your body and create photographic images of your internal bones, organs and other tissue. They are used to look for bone fractures, while chest x-rays are used to diagnose pneumonia. Mammograms use X-rays to find breast cancer.
- PET Scans
- Positron emission tomography — or PET — scans use a radioactive drug to see how your organs and tissue are functioning. The drug, called a tracer, can be swallowed, injected or inhaled. It collects in areas of your body with higher levels of chemical activity. Affected areas show up as bright spots on the scan. PET scans are used to look for cancer, heart problems and brain disorders.
Medicare beneficiaries pay 20 percent of the Medicare-approved costs for these types of tests if they are done in your doctor’s office or in a testing facility. You also have to pay your Medicare Part B deductible.
If you have the tests done in a hospital outpatient setting, you also have to pay a copayment out of your pocket for diagnostic nonlaboratory tests.
In addition, Medicare covers certain preventive services — tests and screenings — that can help find or prevent a medical issue.
8 Cited Research Articles
- U.S. National Library of Medicine. (2020, November 5). X-Rays. Retrieved from https://medlineplus.gov/xrays.html
- Ledbetter, S. (2020, April 2020). Does Medicare Cover MRI Scans? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-mri-scans
- GE Healthcare. (2019, July 25). How Much Does an MRI Cost? Retrieved from https://www.gehealthcare.com/feature-article/how-much-does-an-mri-cost
- U.S. Centers for Medicare & Medicaid Services. (2018, April 10). National Coverage Determination (NCD) for Magnetic Resonance Imaging (220.2). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=177&ncdver=6&bc=AAAAAAAAAQAA&
- American Heart Association. (2015, July 31). Electrocardiogram (ECG or EKG). Retrieved from https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg
- U.S. Centers for Medicare & Medicaid Services. (n.d.). MRI Scan of Brain Before and After Contrast. Retrieved from https://www.medicare.gov/procedure-price-lookup/cost/70553/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Diagnostic Non-Laboratory Tests. Retrieved from https://www.medicare.gov/coverage/diagnostic-non-laboratory-tests
- Mayo Clinic. (n.d.). Positron Emission Tomography Scan. Retrieved from https://www.mayoclinic.org/tests-procedures/pet-scan/about/pac-20385078