Does Medicare Cover Mammograms?
Mammograms are one of the best ways to detect early signs of breast cancer. Medicare covers a free mammogram screening each year for women 40 and older at no cost. Diagnostic mammograms are covered more frequently when medically necessary, although deductibles and copays may apply.
What Is a Mammogram?
A mammogram is an X-ray image of your breasts. Doctors use this preventative service to look for early signs of breast cancer.
Mammograms play a key role in early breast cancer detection and help decrease breast cancer fatalities.
During a mammogram, your breasts are compressed between two plastic plates to spread out the breast tissue.
An X-ray then captures images of your breasts that are displayed on a computer screen. A doctor examines these images to screen for signs of cancer.
Having a mammogram is uncomfortable for many women. But the test only lasts a few moments, and the discomfort is over soon.
Who Needs a Mammogram?
There is no ideal age to start screening for breast cancer.
Recommendations from many experts and medical organizations differ on when women should begin regular mammograms or how often the tests should be performed
However, there are a few general guidelines.
Many women with an average risk of breast cancer often start getting mammograms around age 40.
The American Cancer Society suggests that women with an average risk of cancer undergo annual mammogram screenings at age 45 until age 54, and then follow up with additional screenings once every two years.
Women with a high risk of breast cancer may want to begin screening mammograms at an earlier age.
If you have several high-risk factors, such as a family history of breast cancer or a history of precancerous breast lesions, your doctor may also recommend a magnetic resonance imaging, or MRI, in addition to your mammogram.
Does Medicare Pay for Mammograms?
Mammograms are covered under Medicare Part B. Medicare Advantage plans cover screening mammograms as well.
- One baseline mammogram for women between the ages of 35 and 39.
- One free screening mammogram every 12 months for women age 40 and older.
- Diagnostic mammograms more frequently than once a year when medically necessary.
What Types of Mammograms Are Covered by Medicare?
There are two primary types of mammograms Medicare will cover.
- Screening Mammography
- A radiologic procedure for women with no signs or symptoms of breast disease. This test is used for early detection of breast cancer and includes a physician’s interpretation of the results. This test must include at least a two-view exposure (cranio-caudal and a medial lateral oblique view) of each breast to be covered by Medicare.
- Diagnostic Mammography
- A radiologic procedure for patients with signs and symptoms of breast disease, a family history of breast cancer, or a personal history of benign breast disease. It includes a physician's interpretation of test results.
More specifically, there are conventional, digital and 3D mammograms. Medicare will cover these services so long as your doctor accepts Medicare.
Your Medicare Costs for Mammograms
You pay nothing for a yearly screening mammogram so long as your doctor accepts Medicare.
However, if your doctor recommends more frequent tests, such as a diagnostic mammogram, you will owe 20 percent of the Medicare-approved cost. The Part B deductible — $233 in 2022 — also applies.
A Medicare Supplement plan, or Medigap, can help you cover remaining out-of-pocket costs.
Your costs for a diagnostic mammogram may differ if you have a Medicare Advantage plan, or secondary insurance, such as Medicaid.
5 Cited Research Articles
- Centers for Disease Control and Prevention. (2020, September 14). What is a Mammogram? Retrieved from https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm
- Mayo Clinic. (2019, July 31). Mammogram. Retrieved from https://www.mayoclinic.org/tests-procedures/mammogram/about/pac-20384806
- American Cancer Society. (2019, May 13). Medicare Coverage for Cancer Prevention and Early Detection. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-coverage-for-cancer-prevention-and-early-detection.html
- Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Mammograms (220.4). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=186
- Medicare.gov. (n.d.). Mammograms. Retrieved from https://www.medicare.gov/coverage/mammograms