Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
Medicare Part B (Medical Insurance) covers a:
- Screening mammogram once every 12 months (11 full months must have passed since the last screening)
- Diagnostic mammogram when medically necessary
- Women with Medicare 40 or older are covered
- Women with Medicare between 35-39 can get one baseline mammogram
Your costs in Original Medicare
- Screening mammogram: You pay nothing for the screening test if the doctor or other qualified health care provider accepts assignment
- Diagnostic mammogram: You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.