Does Medicare Cover Mammograms?

With the rising prices of medical procedures and tests, it's important to be aware of medical costs and Medicare coverage so that you don’t end up paying thousands of dollars.

Screening and diagnostic mammograms are an important part of regular women's health checkups, but many people don't know whether Medicare covers them and how much they’ll cost.

In this article, we'll explore whether Medicare covers mammograms, what coverage they offer for different mammograms, and what other cancer-related therapies and screenings they will pay for.

Does Medicare Cover Mammograms and Cancer Treatment?

Medicare is a federal government program run by the CMS (Centers for Medicare and Medicaid Services) that provides health coverage for seniors over the age of 65, people of all ages with certain disabilities, and those who suffer from ESRD (End-stage Renal Disease) and ALS (Lou Gehrig’s). 

Original Medicare does cover diagnostic breast screening tests. However, some types of mammogram screenings are only covered partially by Medicare and there are out-of-pocket costs you’ll need to cover such as your deductible.

Here are the different mammogram coverage options that Medicare offers:

- Screening mammograms are covered once every 12 months for women who are aged 40 and older. If you’re at high risk for breast cancer, you may be eligible for more frequent mammograms.

- Baseline mammograms: Medicare will cover one baseline mammogram for all their members when they enroll in the program.

- Diagnostic mammograms: If you’re enrolled in Medicare, you’ll be covered for all diagnostic mammograms at Medicare-approved rates. 

If you have a mammogram as part of a screening for cancer, it will generally be covered under Medicare Part B.

But remember that with Part B, Medicare will not cover all medical costs and there are limits to the coverage you can get for cancer-related costs.

Medicare plans only cover screening mammograms and will only pay 80% of the costs for medical expenses, including 80% of the cost of your screening test. 

You'll still need to pay 20% of the Medicare-approved amount after you've met your yearly Part B deductible. In 2022, the Part B deductible is $233.

If your mammogram costs more than the approved amount, Medicare will pay 80% of the approved amount; you’ll need to cover 20% and you’ll need to pay the difference.

For example, let’s say a person’s screening mammogram cost comes to $750. Medicare will pay 80% of this bill ($600) and you’ll have to pay 20% ($150).

If you’re unsure whether Medicare will cover your mammogram, our advice is that you phone your local SHIP (State Health Insurance Assistance Program) or check with your Medicare Advantage provider to see what types of mammograms are covered under your plan.

In order to get Medicare to cover a mammogram, you’ll need to have a registered physician prescribe the test and then submit a request for prior authorization.

If you don’t do this, Medicare may reject your claim and you will be liable for the entire cost of the mammogram.

Medicare Advantage Coverage for Mammograms

Medicare Advantage is required by law to offer a member the same level of coverage as an Original Medicare beneficiary.

This is known as minimum equivalent cover and basically means that Medicare Advantage members will get the same level of treatment as a person who has Original Medicare.

However, on top of this Medicare Advantage Plans usually provide additional benefits to their members for a range of medical services, tests, and items not covered by Original Medicare.

You’ll need to check with your Medicare Advantage provider to see what additional services they offer you, but some examples include:

• Transportation to and from your mammogram.

• Free or reduced prices for using in-network doctors.

• Meals and checkups after in-hospital visits.

The best way to find out what your plan offers is to speak with your insurance agent who sold you the plan or to look at your Medicare Advantage Plan contract.

Reach out to one of our agents if you’re interested in finding a Medicare Advantage plan that offers additional benefits for mammograms, breast cancer screenings, tests, and other cancer screenings.

Source: Pixabay

Does Medicare Cover Mammograms of All Types?

While Medicare will offer some coverage for all mammograms, you’ll need to keep in mind that they won’t pay for all cancer-related screenings or treatment. 

A mammogram is a radiological procedure that involves taking an X-ray of the breast. It can help find breast cancer early when it's small and before it has spread. Most women aged 50 and older should get a mammogram every two years. 

Let’s look at the different types of mammograms and what coverage Medicare offers for each one.

Diagnostic mammograms are more detailed than screening mammograms. A diagnostic mammogram usually takes longer than a screening mammogram because more pictures are taken. 

Screening mammography are X-rays of the breast used to find breast cancer early when it is most treatable. Medicare covers screening mammograms once every 12 months for women who are 40 years of age or older.

3D mammograms (breast tomosynthesis) is a newer type of mammogram that creates a three-dimensional image of the breast. It is used along with a regular mammogram. 

Medicare will cover all three types of mammograms, but just remember that it won’t cover 100% of the costs. You may have a mammogram that is just a diagnostic mammogram or you may need both a screening mammogram and a diagnostic mammogram.

Source: Pexels

Other Cancer Screening Tests Covered by Medicare Part B

Here are some of the other cancer screening tests that are used in the diagnosis of breast cancer:

Breast ultrasound is an imaging test that uses sound waves to create a picture of the inside of your breast. It is used along with mammograms to screen women who have dense breast tissue or to help diagnose breast problems. 

Medicare will cover a breast ultrasound if it’s ordered by a doctor as part of a diagnostic mammogram, or if you have a breast mass or lump that can’t be seen on a mammogram.

Magnetic Resonance Imaging (MRI) is an imaging test that uses powerful magnets and radio waves to create a detailed picture of the inside of your breast. 

MRI is used to screen women who are at high risk for breast cancer, such as those with history of ovarian or breast cancer in their family and those who have undergone radiation therapy in the past.

While mammograms are an important tool in the early detection of breast cancer and cancer prevention, it’s important to remember that they are not perfect.

Be sure to talk to your doctor about your risk factors and if you have any concerns, get screened regularly, as recommended by your doctor.

Source: Pexels

Source: Pexels

How Much Does the Average Mammogram Cost?

The cost of diagnostic mammograms, 3D mammograms, and breast ultrasounds will depend on your location and the facility you use. 

However, here are some general indications of what the different types of mammograms might cost you: 

The cost of a mammogram at Breast Cancer Care WA is $120 for a 2D mammogram and $250 for a 3D mammogram. The cost of a breast ultrasound at Breast Cancer Care WA is $200. 

Diagnostic mammograms typically cost anywhere from $50 to $250. 3D mammograms typically cost anywhere from $100 to $400. Breast ultrasounds typically cost anywhere from $100 to $500. 

If you have private Medicare insurance, it’s important to check with your insurance provider to see if they cover the cost of mammograms. Keep in mind that some Medicare Advantage providers may require a co-payment for extended treatments.

What Other Women's Health Care Does Medicare Cover?

Medicare helps pay for a wide range of services related to breast cancer treatment, including:

- Surgery.

- Radiation therapy.

- Chemotherapy.

- Hormone therapy.

- Targeted therapy.

- Clinical trials.

Source: Unsplash

Where Can I Learn More about Medicare and Coverage?

While Medicare pays the costs of some mammogram procedures, there are still some out-of-pocket costs that you should keep in mind.

If you’re interested in learning more about Medicare and coverage, be sure to visit our Medicare hub to read our latest articles.

If you need assistance from one of our Medicare agents to discuss Medicare costs, Medicare Advantage plans, or Medicare Supplement Insurance, you can reach us at 1-888-912-2132 or help@policyscout.com.