Does your Medicare Plan Cover MRI Scans?

Medicare Benefits Solutions
Oct 13, 2021

Has your doctor ordered diagnostic procedures like a CT scan? This may have you wondering does Medicare cover MRIs. If your healthcare provider determines the MRI scan is medically necessary for a proper diagnosis of a chronic health condition, then Medicare should cover the costs.

What is an MRI?

An MRI, which stands for magnetic resonance imaging, is an innovative tool used by physicians to diagnose certain illnesses or injuries. The MRI uses a magnetic field and computer-generated radio waves and creates detailed images of organs and tissues.

The MRI scan is a procedure often used to diagnose a broad spectrum of injuries and diseases. For example, your doctor may order images of your brain and spinal cord if multiple sclerosis or a stroke is suspected. Heart and blood vessels will be the focus if your doctor is looking for a blockage. The MRI machine will be positioned to capture images of bones and joints to detect joint or spinal abnormalities.

As a screening measure, doctors may prescribe an MRI in addition to mammography for high-risk breast cancer patients. This approach leverages the machine’s ability to produce high-resolution images beyond the capacity of a mammogram.

TIP: Read our companion blog to discover if Medicare covers x-rays.

MRI Procedure Costs

The cost of getting an MRI scan done without insurance ranges from around $400 for a bone scan to upwards of $6,000 or more for a brain scan.

Conditions for an MRI to be covered by Medicare:

  • You get the MRI at an imaging facility or hospital that accepts Medicare
  • Your healthcare providers have prescribed the procedure as a diagnostic tool to help manage a specific medical condition
  • The doctor ordering the MRI procedure accepts Medicare

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Medicare Part B MRI Coverage

Medicare Part B covers medically necessary outpatient services and certain types of medical equipment. Though Medicare Part B includes many preventive services, non-laboratory tests are covered as a diagnostic tool.

Non-laboratory tests covered under Medicare Part B include:

  • MRIs
  • X-rays
  • Computer tomography (CT) scan
  • Positron emission tomography (PET) scans
  • Electrocardiogram

In addition to the Medicare Part B deductible, a monthly premium, and 20% coinsurance, you may be responsible for a copayment if the test is performed in a hospital outpatient setting.

TIP: While Medicare Part B provides coverage for outpatient medical services, Medicare Part A would cover the cost if the MRI is ordered during an inpatient hospital stay.

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MRI Scan Procedure

The procedure entails lying on a table that slides into a long and narrow, open-ended, tube-shaped machine, which takes three-dimensional images of the organs, tissues and bones requiring evaluation. Through a microphone, you can speak with the technician who will monitor the test from another room.

Common areas where an MRI may be used include:

  • Shoulder
  • Pelvis
  • Leg
  • Knee
  • Hip
  • Abdomen
  • Brain
  • Chest

A radiologist analyzes and interprets the images and shares the results with your doctor. This detailed information enables your doctor to formulate a diagnosis and recommend a tailored treatment. The scan is a noninvasive, painless procedure. But you should make your doctor aware of anything that may interfere with your ability to take the test.

TIP: Try the Medicare Plan Finder to find and compare plans available in your area.

MRI Considerations to Discuss With Your Doctor

Let your doctor know if you are pregnant. The National Institute of Biomedical Imaging and Bioengineering recommends avoiding MRI scans during the first trimester of pregnancy.

Speak up if you have claustrophobia, especially if your test is expected to take a long time. The facility may accommodate you with music, videos or medication to induce drowsiness and reduce anxiety. Some testing centers have new machines open on the sides, which may lessen the feeling of being closed in.

Because the machine harnesses a powerful magnetic field, you may not be eligible for an MRI if any metal is present in your body. Examples of internal metal devices are pacemakers, intrauterine devices, artificial joints, shrapnel, metal pins, surgical staples and artificial heart valves.

TIP: Learn if Medicare covers routine lab work.

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