Does Medicare Cover Mammograms?
Mammograms are an important preventive service covered under Medicare. Medicare Part B covers mammograms once every twelve months or twice a year for high-risk individuals. High-risk individuals are those with a family history or a genetic predisposition to breast cancer.
However, the screening must meet certain 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 Three 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 mammography: This mammogram 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 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.
You are eligible for one baseline mammogram between 35-39 years old and one screening mammogram every calendar year for women aged 40 and above.
If you get diagnostic mammograms from a participating provider, they are covered at 80% of the Medicare-approved cost. Once you’ve met your Part B deductible ($164.90 in 2023), 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.
It is worth noting that Medicare Advantage plans offer the same services as original Medicare with additional benefits that may include routine vision, hearing, and dental coverage without or with a low copay.
However, it’s essential to check with the plan provider about the costs and coverage of mammograms and any additional tests that may be required.
What If I Can't Afford A Mammogram?
Fortunately, Original Medicare covers preventative screenings at no additional cost to beneficiaries. 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 once every twelve months or every six months for high-risk individuals. However, seniors may still need to pay out of pocket for tests following an abnormal mammogram and if there are any symptoms of breast cancer.
Additional Medicare 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 the necessary breast cancer screening services.
Sources: Medicare.gov – AARP – HealthNews
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