Will Medicare Cover Annual Mammograms?

Medicare provides coverage for various types of mammograms, which are X-rays used to screen for or diagnose breast cancer. Annual preventive breast cancer screenings are covered by Medicare without copays, while mammography exams used to formulate a diagnosis will require cost sharing.

See the rest of the article below to learn more about when Medicare covers mammograms including the age at which you become eligible for coverage and what your share of the costs may be.

On This Page

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  Does Medicare Cover Mammograms?

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  When Did Medicare Start Covering Mammograms?

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  Do I Need a Referral for a Screening Mammogram With Medicare?

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  Does Medicare Have Age Limits for Mammogram Coverage?

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  When Does Medicare Stop Covering Mammograms?

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  How Much Is a Mammogram Out of Pocket?

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  FAQs

Does Medicare Cover Mammograms?

In general, Medicare does cover mammograms, though the extent of coverage may depend on the type of mammogram you receive and your age. Medicare will cover a single baseline mammogram for women between the ages of 35 and 39, followed by screening mammograms once per year for women who are 40 years old or older.^[1] Keep in mind that, if you are under the age of 65, you can generally only qualify for Medicare if you have a disability, end-stage renal disease or ALS.^[2]

Meanwhile, Medicare will cover diagnostic mammograms more than once per year as long as a doctor determines that they are medically necessary for you.^[1] Unlike baseline and screening mammograms, Medicare coverage for diagnostic mammograms also extends to men.^[3]

When Did Medicare Start Covering Mammograms?

While diagnostic services were covered by Medicare when it was first established in 1965, preventive services such as screening mammograms were not eligible for coverage until after the passage of the Omnibus Budget Reconciliation Act of 1990.^[4]

What Part of Medicare Cover Mammograms?

Mammography exams that Medicare will agree to pay for are covered under Medicare Part B, also known as medical insurance. This part of Medicare covers several types of outpatient care including preventive services, doctor visits and medical supplies.^[1]

Do I Need a Referral for a Screening Mammogram With Medicare?

You shouldn’t need a referral from your primary care physician to get a screening mammogram but you will likely need one to get a diagnostic mammogram. According to Armen Gazaryan, a medical expert and the chairman of CalltheCare, there are multiple warning signs women should look out for so they will know whether they need to talk to a doctor about getting a referral.

“A woman may need a referral to get a diagnostic mammogram if she is experiencing symptoms that include a lump on her breast, change in breast shape or size, nipple discharge or skin change, including dimpling or redness,” Gazaryan said in a message to SmartFinancial. “Early detection is key in such situations; hence talking with the provider will ensure one is taking the right step.”

Does Medicare Have Age Limits for Mammogram Coverage?

Remember that Medicare does not start covering mammograms until you are 35 and won’t cover annual mammograms until you are 40. However, there is no maximum age for Medicare mammogram coverage, so once you start to get annual Medicare-covered breast cancer screenings, you are free to continue getting them every year for the rest of your life.^[5]

When Does Medicare Stop Covering Mammograms?

Baseline and annual screening mammograms are covered by Medicare with no coinsurance as long as you visit a health care provider who accepts assignment, meaning your free coverage only ends if you want to receive more than one mammogram before the age of 40 or more than one screening mammogram per year afterward. Conversely, you must pay 20% of the bill for diagnostic mammograms after you meet your deductible for the year but there is no limit on the amount of medically necessary mammograms that Medicare will cover.^[1]

How Much Is a Mammogram Out of Pocket?

Across the United States, Americans pay an average of $400 for two-dimensional screening mammograms and $658 for three-dimensional diagnostic mammograms without insurance.^[6] This means that, if you’re on Medicare and have hit your annual deductible, you can expect to be charged a coinsurance payment of $131.60 on average for a diagnostic mammogram.