Does Medicare Cover Mammograms?
Mammograms are an essential preventive service covered under Medicare. Medicare Part B covers mammograms once every twelve months for any beneficiary 40 or older and twice a year for those considered high-risk individuals by their doctor. High-risk individuals are those with a family history or a genetic predisposition to breast cancer.
However, the screening must meet specific criteria to be covered under Original Medicare. It must be performed at a Medicare-certified facility that meets the minimum requirements for quality standards.
What Types of Mammograms Will Medicare Cover?
Medicare will cover three types of mammograms:
- Screening mammogram: This type of mammogram checks for breast cancer in women with no signs or symptoms. The goal is to detect abnormalities in the early stages before they become life-threatening.
- Diagnostic mammogram: This type of mammogram is used to diagnose a specific area or symptom of concern. It involves an X-ray exam and additional views from different angles to get better images of the affected area.
- Digital mammogram: This mammogram is also considered diagnostic and uses high-resolution digital X-rays instead of traditional film X-rays. It can provide more detailed images and help identify more minor abnormalities.
How Much Do Mammograms Cost With Medicare?
Medicare Part B offers full Medicare coverage for baseline (first-time) and yearly screening mammograms with no out-of-pocket costs. If your doctor or healthcare provider accepts the assignment, you won’t have to pay anything – no deductible or coinsurance.
Women are eligible for one Medicare-covered baseline mammogram between 35 and 39 years old and one yearly screening mammogram for age 40 and above.
If you receive diagnostic mammograms from a participating provider, they are covered at 80% of the Medicare-approved cost. Once you’ve met your Part B deductible ($240 in 2024), you’ll only pay 20% coinsurance.
If you have a Medigap plan, some or all of those gaps can also be covered. The out-of-pocket expenses may differ based on your doctor’s charges and any other insurance you may have. However, it’s essential to check with the plan provider about the costs and coverage of mammograms and any additional tests you may need.
What if I Can't Afford a Mammogram?
Fortunately, Original Medicare covers yearly preventative screenings at no additional cost to beneficiaries 40 and older. However, if diagnostic screenings are necessary, there may be out-of-pocket expenses.
If you cannot afford these gaps in coverage, it’s worth considering the purchase of a Medicare Supplement plan or exploring Medicare Advantage plans.
For those who require prescription medications as part of their treatment, Medicare offers financial assistance to help with the cost. The ‘Extra Help’ program provides qualified individuals with low or no-cost coverage for Medicare-related expenses. To qualify, seniors must meet specific income and asset criteria.
Bottom Line
In conclusion, Medicare covers mammograms:
- One time between the ages of 35-39
- Once a year for those aged 40 and older
- Twice a year for high-risk individuals
However, seniors may still need to pay out of pocket if:
- Tests are required following an abnormal mammogram
- A diagnostic mammogram is needed
- There are symptoms of breast cancer
Some Medigap plan types can help fill in the gaps in out-of-pocket expenses. Also, Medicare provides additional financial assistance if you cannot afford your out-of-pocket prescription expenses.
Knowing these important details can help seniors stay on top of their health and receive necessary breast cancer screening services.
Sources: Medicare.gov – AARP – HealthNews
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