Does Medicare Cover a Mammogram?

Medicare Benefits Solutions
Oct 1, 2020

Medical research and development have made huge strides in the treatment of breast cancer over recent decades, but for many women, early detection remains a priority for the best outcomes. As well, mammograms continue to be some of the most effective diagnostic tests used to detect breast cancer early.

No matter your age, all women are encouraged to work with their doctors to discuss breast cancer testing. This means that older women, even those who have gone through menopause, should ensure that breast cancer screening is a regular part of their health and wellness schedule.

Does Medicare Cover Mammograms?

In the vast majority of cases, Medicare coverage does provide benefits for mammograms. This coverage includes one annual screening for women over 40 who receive Medicare benefits, but younger women may also be able to obtain one baseline screening from ages 35 to 39. You may also be covered for more frequent diagnostic mammograms if your doctor feels it is medically necessary. Remember that Medicare typically provides coverage for seniors, but it can also be used to insure younger individuals who have certain qualifying disabilities.

What Parts of Medicare Cover Mammograms?

Mammograms are usually covered by Medicare Part B when ordered by a physician as part of preventive care or as a medically necessary procedure. Part B will cover the annual screening, but it can also cover the cost of diagnostic screenings on a more regular basis if they are part of a treatment or monitoring plan.

If you get a mammogram for diagnostic purposes, you’ll likely be responsible for 20% of the cost of the screening, and the Part B deductible applies. Mammograms that are administered in a hospital during admittance may be covered by Medicare Part A as this is the inpatient benefit. What you need to know is that hospitals often bring in specialists from nearby medical offices to perform tests and administer treatment. If the hospital itself is not providing the mammogram, even if the mammogram is performed at the hospital, you may be billed separately by the attending physician.

Medicare Part D, the prescription drug benefit, would have no bearing on your mammogram coverage, but it may cover the cost of certain drugs used to treat breast cancer and related symptoms if the disease is found. This coverage is only available for medications sold in retail pharmacies. If you require the administration of medications in a hospital or clinical setting, the medications used would likely be covered by Medicare Part A or Medicare Part B, respectively.

Medicare Part D, the prescription drug benefit, would have no bearing on your mammogram coverage, but it may cover the cost of certain drugs used to treat breast cancer and related symptoms if the disease is found. This coverage is only available for medications sold in retail pharmacies. If you require the administration of medications in a hospital or clinical setting, the medications used would likely be covered by Medicare Part A or Medicare Part B, respectively.

Does Medicare Advantage Cover Mammograms?

Medicare Advantage plans often give you additional benefits on top of those offered through Original Medicare coverage, and these extra benefits may extend to mammograms. Some Medicare Advantage plans give plan members a wider network of providers to choose from, and you may also be able to take advantage of additional diagnostic screening procedures for a variety of medical conditions. Each plan and provider is different, however, so you will need to speak with a representative from your Medicare Advantage administration office for details about what is available to you.