Does Medicare Cover Mammograms?

Learn if mammography is covered by Original Medicare

by Ray Wilson+ on Aug 01, 2015 | 16 Comments

Mammograms are very important for women, especially after 40. Mammograms are x-ray pictures of the breast that check for breast cancer in women have no symptoms or signs. This test can be expensive, so if you are Medicare-eligible you may wonder if Medicare covers the exam at all, and if it does how much you have to pay.

Are Mammograms Covered By Medicare?

Yes. Not only are mammograms covered by Medicare, the yearly exam is FREE. However if you need a diagnostic mammogram, you will pay 20% of this cost. How much will that be for you? Well that is more complicated because each medical provider that offers diagnostic mammograms can charge a different price.

Does Medigap cover Mammograms?

Medigap plans fill in the gaps of Original Medicare, therefore, yes, Medigap plans can cover the unforeseen cost of your diagnostic mammogram. Plans like “C” and “F” cover your Part B deductible, copays, and coinsurance, and you should not have any out of pocket costs after your monthly Medigap premium with these plans. Check out Medigap plans side by side to see which one cover the Part B coinsurance and copays.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Mammograms

Medicare Advantage does cover mammograms. With MA plans you still have the free preventive exam; however, since Medicare Advantage plans are not standardized, you’ll have to research how each company and plan cover diagnostic mammograms -remember MA plans must cover everything that Medicare does, but it can vary the way they charge for coverage.

Learn More about Medicare Advantage Get a MA Quote

To learn more about what Medicare covers call a Senior65 agent 800-930-7956.

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Reader Comments and Questions

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By Chris on July 18, 2018

I have a Medicare Advantage plan. I have been diagnosed with breast cancer, had a mastectomy of my right breast. My breast surgeon requests that I can only have a diagnostic mammogram of my left (normal) breast with my previous history. My insurance has denied payment of my diagnostic mammogram and tomosyntheis (3D mammogram) the past two years. I have to pay the contracted portion. Medicare does make a provision for coverage of diagnostic mammograms when medically necessary. Any suggestions in winning this battle. Cost of screening and diagnostic mammograms is essentially the same.

Hi Chris
It really depends on your insurance plan and provider. If you used Senior65 when you enrolled in your Medicare Advantage plan, we can help look into this issue. If not, you will want to reach out to your local agent to see what can be done. Remember you will be able to switch plans for 2019 so if your insurance provider is not working with you it may be time to find a new plan. We can help with the switching process.
-Michelle from Senior65.com


By Kathleen on June 11, 2018

I am 73 years old, soon to be 74. I recently went for my yearly mammogram with a prescription from my doctor, and I was denied. I was told Medicare would only do the mammogram every two years after the age of 70. I have had abnormal results on my mammograms because of fibrocystic breast disease, but I was told this didn't make any difference. I haven't read or heard that Medicare reduced the number of times women over 70 could get mammograms.

Kathleen,
There is nothing in Medicare's 2018 guidelines that states that women over 70 cannot get a mammogram each year. We recommend contacting Medicare directly again to get them to clarify why your mammogram was not covered.
-Eric from Senior65.com


By Elizabeth on April 27, 2018

I just turned 80 years old. I have had a mammogram every year. Does Medicare pay for a routine yearly mammogram ages 80 and older?

Elizabeth,
Thank you for contacting Senior65. Our understanding is that there is no upper age limit to mammogram coverage according to Medicare.gov. Mammorgrams should be covered each year after you turn 40. You should confirm with your care provider or Medicare directly at 1-800-633-4227.
-Michelle from Senior65.com


By Renee on April 23, 2018

I had my yearly mammogram in March, at that time they saw a spot on my breast. I had to go back and have another 3D one done at which time I was told they were just going to watch it. My work insurance took care of the cost since it was a preventative measure. I have now received a bill for $850.00 for the second test and reading. Can I use my Medicare as a secondary insurance even though I have coverage through my employer? If so do I give the hospital insurance billing department my Medicare information to run it through? Thank you in advance for your response!

Renee,
Thanks for your question. If you have both Medicare and work-related coverage it will depend on the size of the company which group will pay first for Medical expenses. Since we don't have the details of your work coverage, please contact your HR department and they can help explain if Medicare can pick up some of that expense. Should you ever leave your work coverage, please keep us in mind. When your work coverage ends you are able to enroll in a Medigap or Medicare Advantage plan and we could help you enroll and guide you on exactly how the benefits work.
-Michelle from Senior65.com


By Michaele on January 16, 2018

will Medicare over mammogram after 75?

Michaele
Medicare does not list an age limit for mammogram screening on the information available to agents. You would want to contact your doctor or Medicare directly at 1-800-633-4227 to confirm how this screening works for those over 75
-Michelle from senior65.com


By SANDRA FLEISCHMANN on May 10, 2017

If a patient had a diagnostic mammogram on 6/21/16 and is now scheduled for a screening mammogram on 5/11/17 will medicare cover the costs of this exam?

Sandra,
It usually needs to be a full 11 months between exams; however, since it will be almost 11 months, you will want to contact Medicare directly to see if they make an exception and cover the mammogram.
-Amy from https://www.senior65.com/


By Frieda Romine on March 31, 2017

Does Medicare cover mammograms after age 75? Thank you.

Frieda,
Medicare covers a mammogram every 12 months, and does not have a cut off age. For more specific Original Medicare coverage, you will want to contact Medicare directly.
-Michelle from https://www.senior65.com/


By anita defazio on January 24, 2017

I am due for my annual mammogram and am offered tomosynthesis? Is this covered too?

Anita,
It appears the answer is yes, but you will always want to confirm with Medicare how they cover a service.
-Amy from https://www.senior65.com/


By Lenore levy on August 29, 2016

It is my understanding that while Medicare pays for a mammogram every year, I only need a doctor's script every OTHER year. The reason I was told is that I can only get a gynecological every other year. Is this correct or do I need a prescription for a mammogram every year even if Medicare will not pay for a yearly visit?

Lenore,
You are able to get an order for a mammogram from your general doctor for the off year that you are not seen by your gynecologist. If you prefer not to do that, you should contact CMS directly to see if you can avoid an order for a mammogram in your off year.

If you would like to enroll in a Medicare Supplement or Medicare Advantage plan to off-set the costs of diagnostic mammograms, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Nancy Kowalski on August 10, 2016

I would like to know if my Medicare Plan F covers 3D Mammography? Thank you

Nancy,
Medigap Plan F covers diagnostic mammograms. However, you will want to confirm with Medicare that they cover a specific version of a test -as Medigap plans only fills in the gaps of Original Medicare. Hope this helps!
-Amy from https://www.senior65.com/


By Ty on August 05, 2016

Does medicare cover 2D and/or 3D mammograms ? I also have Tricare For Life.

Ty,
Medicare does cover 2D and 3D mammograms; however, there may be restrictions. You will want to contact Medicare directly to find out if you qualify.
-Chris from https://www.senior65.com/


By mary jane costa on July 12, 2016

My mammogram last year was 8/31/15 and this year I am scheduled for 8/29/16. Is this test covered by Medicare within this time frame? Thank you

Mary Jane,
Mammograms are covered as long as a full 11 months has been passed since your last screening -according to Medicare. As always, we suggest contacting Medicare to confirm all care. Hope this helps!
-Amy from https://www.senior65.com/


By SHARON on March 24, 2016

This question is from an imaging facility. A medicare covered patient has a physical finding on one breast. She is 6 days early for her annual bilaterl mammogram. Will a bilateral diagnostic be covered?

Sharon,
She qualifies for a mammogram screening once a year (must be 11 months since last screening). However, if she needs a diagnostic mammogram, she should be covered before the annual screening. She will want to talk to her doctor and Medicare to confirm. If she wants help paying for those costs with a Medigap plan, please contact one our licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Rita Brown on July 16, 2015

I just enrolled in Medigap C, will I have any out of pocket costs if I need a diagnostic mammogram? The reason I am concerned is two-fold, first, I have fixed income, and second, my sister had breast cancer. I think I'll need a diagnostic exam soon, and want to prepare for the costs.

Rita,
With Medigap Plan C, while your diagnostic mammogram (if deemed necessary) deductible will be covered and your copays, you could have excess charges (costs charged by doctors that do not accept to Medicare assignment), and Plan C does not cover this. So, our suggestion, if you don't want extra charges, go to a doctor that accepts assignment. Hope this helps.
-Eric from https://www.senior65.com/


By Dana Read on June 20, 2015

I like free. What other services are free with Medicare?

Dana,
We all like free! Medicare offers $0 preventive care for screenings, vaccinations, wellness visits, and other services.
-Chris from https://www.senior65.com/


By Deanne S. on June 17, 2015

How many likely is it that I'd need a diagnostic mammogram?

Deanne,
That's an excellent question. Only a small group of women will need a diagnostic mammogram (approx 5-15% each year). Hope this helps.
-Michelle from https://www.senior65.com/



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