Does Medicare Cover Mammograms? What You Need to Know
Medicare covers at least one mammogram per year for women over 40.
You can get your first mammogram between age 35 and 39, then one every year to check for breast cancer. Medicare will pay for more than one mammogram each year if your doctor sees something suspicious in your test results.
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Medicare mammogram coverage
Does Medicare cover mammograms?
Medicare covers baseline, screening and diagnostic mammograms.
A baseline mammogram is the first mammogram you get. It's used as a reference for future mammograms to detect changes in breast tissue.
Screening mammograms check for breast cancer even if you don't have symptoms.
Diagnostic mammograms happen when you have signs or symptoms of breast cancer.
- Baseline mammogram: Women between 35 and 39 can get one mammogram for future tests to be compared to.
- Screening mammograms: Women ages 40 and older can get one screening mammogram per year to check for signs of breast cancer.
- Diagnostic mammograms: If you have signs of breast cancer and you're on Medicare, you can get extra mammograms if your doctor orders them, regardless of how old you are.
Because most women qualify for Medicare when they turn 65, they're covered for at least one mammogram per year. If you qualify for Medicare at a younger age because of a qualifying condition or disability, your mammogram coverage starts age at 35 with a baseline mammogram and age 40 for screening mammograms.
How often does Medicare pay for mammograms?
If you're 40 or older, Medicare covers at least one mammogram every year.
- One mammogram between 35 and 39
- One mammogram every year starting at 40
- Additional mammograms as ordered by your doctor
How much does Medicare pay for mammograms?
As long as your doctor takes Medicare, you shouldn't have to pay anything for baseline or screening mammograms.
You'll usually pay between about $40 and $60 if you need a diagnostic mammogram after showing signs of breast cancer.
That's because mammograms usually cost between $200 and $300, and Medicare Part B pays for 80% of the cost of diagnostic mammograms. You'll pay more if you haven't met your Part B deductible yet.
If you have a Medicare Advantage or Medicare Supplement plan, you might pay a lower amount than you would with Original Medicare.
What is a mammogram?
A mammogram is a special type of X-ray that checks for breast cancer.
Women between 40 and 74 who have an average risk of breast cancer should get a mammogram every other year or as often as their doctor recommends.
Types of mammograms
This is the traditional type of mammogram, which creates a two-dimensional image.
A three-dimensional mammogram, also called digital breast tomosynthesis, can help detect breast cancer at earlier stages.
Positron emission mammography, or PEM, uses a radioactive dye injected into your blood to detect cancer cells. It's typically only used if you already have breast cancer.
Does Medicare cover 3D mammograms?
Yes, Medicare pays for 3D mammograms. However, Medicare doesn't consider 3D mammograms to be "primary" procedures. So you may have to get a 2D mammogram first, and you might have to pay for 20% of the 3D mammogram, even if it's a screening test.
Frequently asked questions
Does Medicare cover yearly mammograms after age 75?
Medicare continues to pay for mammograms after age 75. If you're over 40, Medicare pays for one mammogram per year to check for breast cancer. It also pays for extra mammograms if you have signs of breast cancer.
Does Medicare cover annual mammograms?
Medicare pays for annual mammograms for women over 40. These are called "screening mammograms" and they check for signs of breast cancer even if you don't have symptoms.
Do I need a referral for a mammogram with Medicare?
You don't need a referral to get a mammogram with Medicare, and you can get the test anywhere that takes Medicare as payment. If you're over 40, you can get one mammogram each year, called a "screening mammogram," to check for signs of breast cancer. If you have symptoms of breast cancer, Medicare will pay for more mammograms, called "diagnostic mammograms."
Sources
Sources for this article include the American Cancer Society, the Centers for Disease Control and Prevention (CDC), Mayo Clinic, Medicare.gov, the National Cancer Institute, the National Library of Medicine and the U.S. Preventive Services Task Force.
Mammogram cost info comes from the Medicare Procedure Price Lookup tool, using billing code 77047.
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