Medicare pays for an annual mammogram screening for beneficiaries ages 35 and up. According to medicare.gov, Part B covers:
- A baseline mammogram once in your lifetime (if you’re a woman between ages 35-39).
- Screening mammograms once every 12 months (if you’re a woman age 40 or older).
- Diagnostic mammograms more frequently than once a year, if medically necessary.
- Your costs for Original Medicare
If you opt for a mammogram screening, you pay nothing for the screening if your doctor or other qualified health care provider accepts assignment. If you opt for a diagnostic mammogram, after you meet the Part B deductible , you pay 20% of the Medicare-Approved Amount .
However, costs will vary depending on if the mammogram is screening or diagnostic, some of which you may need to pay out of pocket. It is also important to note that diagnostic mammograms usually have a coinsurance cost.
What Is a Mammogram?
Mammograms are x-rays used as a crucial tool in the fight against breast cancer as they can detect or diagnose the symptoms early. Women over forty should book their annual screening mammograms at least once per year, and those who have had certain types of jobs that may put them at higher risk for developing this disease need to get checked more often than others.
What Are the Different Types of Mammograms?
There are three main types of mammography to choose from:
Conventional mammogram: This type of mammogram is taken in 2D. The doctor examines the film for any lumps or other areas of concern using black and white images. These can provide early detection of breast cancer while also allowing you time with your specialist or physician if need be before moving forward with an invasive procedure like surgical removal.
Digital mammogram: Like a conventional mammogram, the digital version takes 2-D black and white images of your breast. However, these are entered directly into a computer which allows doctors to zoom in on areas they need more information about or enhance an image if necessary before printing it out for examination with medical professionals.
3D mammogram: A 3D mammogram takes multiple pictures during the test to produce a comprehensive 3-dimensional view of your breast tissue. This type of mammogram, also known as tomosynthesis or three-dimensional imaging, has improved the diagnosis of cancerous cells in dense breasts.
With Medicare coverage, you can get both conventional and 3D mammograms.
Which Medicare Options Cover Mammograms?
Medicare Part B covers medically necessary outpatient diagnostic and treatment services. You can get screened for breast cancer with Medicare coverage once a year with specific limitations, such as age. In 2023, the Medicare Part B deductible has an annual out-of-pocket cost of $408, which must be met before covering medically necessary services.
Medicare Part C, also known as Medicare Advantage plans are private insurance plans which may offer more benefits than Original Medicare and must provide all Medicare Part B coverage. Because of this, you will automatically receive coverage for your mammogram if you meet the eligibility criteria.
Does Medigap Cover Mammograms?
Medigap is a supplemental insurance option that may help lower your out-of-pocket plan costs. If you have original Medicare and are looking into ways to reduce the cost of mammograms, such as deductibles and copayments, Medigap could be an excellent choice for coverage!
Are All Types of Mammograms Covered by Medicare?
Medicare will cover 80% of diagnostic mammograms, leaving you with 20% to pay. If you have a Medicare Supplement plan, it will cover your 20% coinsurance. Depending on which Medicare Supplement plan you have, you may only be responsible for your small annual deductible.
What Is the Average Cost of a Mammogram?
According to an article in The Journal of Women’s Health, roughly 23% of women reported paying some out-of-pocket costs for a mammogram. Medicare Part B and Medicare Advantage coverage for mammograms include:
- 100% of yearly screening mammogram expenses
- 80% of required diagnostic mammogram expenses
It is worth noting that those with Medicare will not pay anything for their yearly mammogram screening, but there may be out-of-pocket costs for diagnostic mammograms. This amount typically includes premiums and deductible owed, plus the 20% copayments of the Medicare-approved expenses.
How Often Do You Get a Mammogram with Medicare?
With Medicare plan, you can receive:
- one baseline mammogram (between the ages of 35 and 49)
- one screening mammogram every 12 months (if you’re 40 years or older)
- one or more diagnostic mammograms, if medically necessary, to diagnose a condition, such as breast cancer
Does Medicare Cover Mammograms If You’re 65 or Older?
There is no age limit for breast cancer screenings, and you should always book an annual mammogram. Studies show that women aged 60-69 who got mammograms regularly had a 33% lower risk of dying from breast cancer than women who did not get mammograms. It’s important to make a plan with your health care provider and discuss any risk factors or personal history you may be aware of before booking.
How to Get Medicare Coverage for Your Mammograms
Medicare covers one test per 12-month period for screening mammograms for all women on Medicare over the age of 40, in line with the recommended annual mammogram recommendations by the American Cancer Society.
Part B will cover 80% of supplementary mammograms done during the 12 months if considered medically required. If enrolled in a Medicare Supplement plan, it will cover the remaining 20% coinsurance.
To learn more about Medicare Advantage or Medigap plans that suit your needs for mammogram coverage, contact our professionals today.