Medicare coverage for mammograms

Published by Medicare Made Clear®

Mammograms may rival colonoscopies for the least-favorite screening test among women. Despite this, many women stick to a regular schedule of getting them—and with good reason.

Regular mammograms are the standard for detecting breast cancer. And early detection can mean successful treatment. The five-year survival rate for localized breast cancer is now 99 percent, according to the American Cancer Society.1

How often can you get a mammogram on Medicare?

Medicare Part B covers a screening mammogram once every 12 months. Medicare Advantage plans (Part C) cover screening mammograms as well. Check to make sure your doctor or other provider is in the plan network.

You pay nothing for a mammogram as long as your doctor accepts Medicare assignment. If your doctor recommends more frequent tests or additional services, such as a diagnostic mammogram, you may have copays or other out-of-pocket costs.

What is a diagnostic mammogram?

A diagnostic mammogram is used to look more closely at a possible cancer to help determine whether or not it actually is cancer. You may be referred for a diagnostic mammogram if your screening mammogram shows something abnormal.

Medicare Part B covers 80 percent of the Medicare-approved amount for a diagnostic mammogram. You would be responsible for the remaining 20 percent. The Part B deductible would also apply. Some Medigap plans help pay these costs.

Your costs may be different for a diagnostic mammogram if you have a Medicare Advantage plan.

A regular screening mammogram is just one preventive health care service for women that Medicare covers. It’s also a good reason to schedule your annual Medicare Wellness Visit and ensure you’re up to date on all your preventive health screenings.

What other women’s health items does Medicare cover?

Mammograms are just one important item that Medicare covers for women’s health. See this great infographic for more.

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