Does Medicare Cover Mammograms?

According to the World Health Organization (WHO), breast cancer is the most common cancer in the world. In 2020 there were 2.26 million cases.

Breast cancer is also one of the most deadly cancers in 2020. 685,000 people lost their lives due to this disease.

Early detection is one of the best things you can do when it comes to breast cancer. The earlier it is detected, the greater the chances of successfully treating it.

And, as many of you already know, a mammogram is the test medical professionals use to detect breast cancer.

However, mammograms can be a little expensive, and not everyone who needs them may be able to afford them. So a common question many people have is, “does Medicare cover mammograms?”

In this article, we answer that question in clear, plain English. You will also find the average costs of a mammogram, as well as other helpful info.

The short answer is yes; Medicare will cover the cost of a mammogram. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your mammogram. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for mammograms. Coverage for a mammogram falls under Medicare Part B.

Medicare Part B provides coverage for both screening and diagnostic mammograms. If you are a woman between the ages of 35 and 49, Medicare Part B covers one mammogram as a baseline test. If you are 40 years of age or older, Medicare Part B covers one mammogram test each year. Medicare Part B also covers one or more diagnostic mammograms if it is necessary to diagnose breast cancer.

Medicare Part B covers 100% of the costs of a yearly screening mammogram. But if it is a necessary diagnostic mammogram, Medicare Part B covers only 80% of the costs, and you will pay for the remaining 20%.

Medicare Advantage plans (Medicare Part C) also provide coverage for a mammogram test. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

Though both Medicare Part B and Medicare Advantage provide coverage for both conventional mammograms. Coverage for a 3-D mammogram will depend on the provider.

How Much Does It Cost To Have A Mammogram Test?

The average cost of a mammogram test is somewhere between $100 and $250. However, there are also some programs that offer free mammogram tests.

Types Of Mammograms

There are three types of mammograms. They are: conventional and digital, both of which are 2-D, and then 3-D mammograms.

Conventional Mammogram – conventional mammograms take 2-D black and white film images of the breast. During the test, your healthcare provider can view the images and look for lumps, deposits, or other areas of concern.

Digital Mammogram – just like the conventional mammogram, a digital mammogram takes 2-D and black and white film of the breast. But unlike conventional mammograms, it uses a computer to view the images. It is more accurate as it allows the doctor to zoom, enhance, and inspect the image.
3-D mammogram – during a 3-D mammogram test, the doctor takes multiple pictures of the breast to produce a 3-D view of the breast tissue. 3-D mammogram tests have proven to be more effective in diagnosing breast cancer especially for those who have dense breast tissues.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.