Does Medicare Cover Mammograms? A Beginners Guide.

Greg Wilson

Updated on:


    Did you know that the two most significant risk factors for breast cancer are being female and getting older? Experts have recommended mammograms for decades to facilitate the early detection of breast cancers.

    Do you ever worry about coverage by Medicare for mammograms? Please keep reading to learn more about mammograms and how Medicare pays them.

    Purpose of Mammograms

    screening mammogram is an X-ray of the breast using low-dose X-rays. The goal is to detect breast cancer before a person has any symptoms. Breast cancer that’s detected early is often the most treatable.

    How Mammograms Work

    The breast is briefly compressed twice between two plates. The machine makes a radiologic image from two different views. One is top-down, and the other is on an angle from the center of the chest to the side.

    The radiologist examines the image for abnormal areas. If they find anything suspicious, further testing will take place.

    Medicare for Mammograms

    Medicare Part B beneficiaries without symptoms or a history of breast cancer have coverage. Women 35 to 39 years may have one baseline mammogram, while women over 39 may have one screening mammogram each year.

    It’s important to note that Medicare doesn’t cover screening mammograms for men. They will cover diagnostic mammograms for women and men. Providers order this type of mammogram when someone has an identified abnormality.

    Cost of Mammograms

    Screening mammograms have 100% coverage for members who qualify for Part A and B. It will help if you use a Medicare-approved provider, also valid for Medicare Advantage Plans if you meet Medicare requirements.

    80% of the Medicare-approved cost is covered if you have a diagnostic mammogram. After meeting your Plan B deductible, you will need to pay the 20% coinsurance. Your Medicare Advantage Plan’s cost-sharing may apply with in-network providers.

    Cost of Medicare

    Medicare coverage involves many different Medicare plans and supplements. The following briefly overviews standard health plans and their premiums.

    Medicare Part A

    Medicare Part A covers inpatient hospitalization without monthly premiums for most people. If you paid into Medicare for 7.5 to 10 years, your cost would be $263/month. Those who paid into Medicare for less than 7.5 years will pay $478/month.

    Medicare Part B

    Part B covers many outpatient services. Most beneficiaries will pay $153.30/month. This premium depends on the Social Security cost of living adjustment for 2021.

    Medicare Supplements

    Medigap Plan G will cost about $140/month. Yet, rates vary depending on location, use of tobacco products, gender, and age.

    Medicare Advantage Part C requires that you pay the Part B premium. You must also pay the Medicare Advantage monthly premium, about $36/month. This type of plan includes Part D.

    Medicare Part D coverage pays for prescription medications. With enhanced plans, the premium will be about $30.50/month, and some states will cost more.

    Do You Have Questions About Medicare?

    This article answered the question about the coverage by Medicare for mammograms. If you have other questions about Medicare, you’ve come to the right place.

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