Mammograms
Medicare Part B (Medical Insurance) covers mammograms if you're eligible
Description
Mammograms are x-ray pictures of the breast that check for breast cancer. There are different types of mammograms:
- A baseline mammogram (usually your first mammogram) creates a record of your breast tissue that's compared to all future mammograms.
- A screening mammogram monitors your breast health every year.
- Diagnostic mammograms investigate abnormalities, including symptoms or signs of breast cancer.
Your doctor or other health care provider may order a breast ultrasound after a mammogram to check specific areas of your breast.
Coverage details
Part B covers baseline, screening, and diagnostic mammograms.
Medicare only covers
medically necessary
breast ultrasounds when your health care provider orders them.
Who's eligible
- Baseline mammogram: If you’re a woman between 35–39.
- Screening mammograms: If you’re a woman 40 or older.
- Diagnostic mammograms: If it’s medically necessary.
Costs
- Baseline and screening mammograms: You pay nothing for the test if provider accepts assignment .
- Diagnostic mammograms: After you meet the Part B deductible , you pay 20% of the Medicare-approved amount .
How often
- Baseline mammogram: Once in your lifetime.
- Screening mammograms: Once every 12 months.
- Diagnostic mammograms: More frequently than once a year, if medically necessary.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service