How Much Will Medicare Cover if You Need a CT Scan?
Innovative screening tools can be helpful in diagnosing a wide range of diseases and medical conditions. If you’re injured or your doctor needs to confirm a diagnosis, a computed tomography scan may be recommended. If an MRI, CT scan, or other diagnostic test is ordered by your doctor, and you undergo exams within a Medicare-approved facility, you may get help paying for those services.
What is a CT Scan?
If you have ever had an injury or been diagnosed with a disease, you may be familiar with computerized tomography, commonly known as a CT scan. The same test is sometimes referred to as a CAT scan (computed axial tomography).
CT scans capture cross-sectional images of blood vessels, bones and soft tissues from different angles. An analysis of these images provides insight into bone fractures, blood clots and abnormalities indicative of diseases like cancers and heart conditions.
The technology gives doctors a vantage point from which to confirm a diagnosis, formulate a treatment plan, monitor an ongoing condition, or recommend further testing.
Why Do I Need a CT Scan?
According to the Cleveland Clinic, you may need a CT scan if your doctor has reason to suspect a:
- Specific cancer or benign growth
- Fracture or broken bone
- Heart condition
- Blood clot
- Bowel function issues like a blockage or Crohn’s disease
- Brain and spinal cord problems
- Internal bleeding
CT scans can range from hundreds to thousands of dollars depending on a range of factors, including where the test is performed (inpatient or outpatient facility), region of the country, type of scan and insurance coverage. If you are a Medicare recipient, you are probably asking, “Does Medicare pay for CT scans?”
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How Does Medicare Cover CT Scans?
Medicare helps with the cost of medically necessary CT scans and other diagnostic tools that your doctor orders to diagnose, treat or monitor a disease or injury. These tests are covered by Part B if the scans take place in an outpatient setting. If you’ve been formally admitted into a hospital or skilled nursing facility, you may be covered under Medicare Part A.
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Does Medicare Part B Cover CT Scans?
Part B covers specific diagnostic tests, including CT scans. Your share of the cost is the Part B deductible and the 20% coinsurance payment. If your doctor sends you to the outpatient department of a hospital for the test, the outpatient facility may also charge you a copayment.
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Does Medicare Cover Preventive Tests?
Medicare covers CT scans and other preventive tests if you meet specific criteria, usually at no cost to you if you use a Medicare-participating provider who accepts assignment. Accepting assignment means that your doctor has an agreement with Medicare not to charge you more than the Medicare approved amount for services.
Here are examples of Medicare-covered preventive tests:
Bone density test
If you are at risk of broken bones, Medicare covers one bone density test every two years as a preventive measure. One of the following conditions must apply. You may be eligible if you:
- Are a woman with estrogen deficiency and are at risk of osteoporosis
- Potentially have low bone density or vertebral fractures as shown on X-rays
- Take or plan to take prednisone or a type of steroid
- Have primary hyperparathyroidism
- Need monitoring for effects of osteoporosis drugs
In addition to covering EKG as a diagnostic test, Medicare covers a one-time EKG screening if your healthcare provider arranges this as part of your “Welcome to Medicare” preventive visit. You are responsible for the Part B deductible and coinsurance.
CT scans for lung cancer screening
You may be eligible for an annual preventive CT scan as part of lung cancer screening if all the following apply.
- Fall within the age group of 55 to 77
- Be asymptomatic of lung cancer
- Either currently smoke or have quit smoking within the last 15 years
- Have a history of smoking an average of one pack of cigarettes per day for a minimum of 30 years
- Have a doctor’s written order to get the screening
If all of the above is applicable, the screening will be provided at no cost to you, assuming your healthcare provider accepts assignment.
Are CT Scans Covered by Medicare Advantage or Medigap?
Medicare Advantage (MA) is a Medicare-approved plan offered by private insurance companies. MA plans are required to provide the same benefits as Original Medicare Part A and Part B. Many MA plans provide additional coverage, which could include prescription drug coverage, vision and dental care, gym memberships, and more.
If you need a CT scan and have a Medicare Advantage plan, check your plan benefits for more specific information. You will have at least the same coverage as Part A or Part B, but you may have access to other services.
Medigap (Medicare Supplement) plans help cover some of the costs that Original Medicare does not. Depending on the Medigap plan you purchase, it might pay the Part A coinsurance if you are hospitalized. If you are an outpatient, Medigap may cover your Part B coinsurance and copayments. All Medicare Supplement plans except Plan A cover the Part A deductible with benefit levels ranging from 50% to 100%, depending on the policy.
Keep in mind that you cannot have a Medigap plan if you are enrolled in Medicare Advantage (Medicare Part C).
How Much Will You Pay for a CT Scan?
What you pay for a CT scan will depend on a number of factors, including the reason for your scan, what medical providers you visit, where you live, and what plan you’ve enrolled in. Talk to your physician to discuss any questions you may have and reach out to your plan directly for more details.
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