Does Medicare Cover MRIs? Coverage and Your Costs

Magnetic Resonance Imaging, commonly known as an MRI, is a widely used diagnostic imaging tool. This technology employs powerful magnetic fields and radio waves to generate detailed images of internal body structures, assisting healthcare providers in diagnosis. This article provides an overview of how Medicare covers MRIs and associated costs.

Original Medicare Coverage for MRIs

Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), covers Magnetic Resonance Imaging scans under specific conditions. Outpatient MRIs are primarily covered under Medicare Part B, which addresses diagnostic tests ordered by a healthcare provider. This includes scans performed in a doctor’s office, independent diagnostic testing facility, or hospital outpatient department.

For coverage to apply, the MRI must be considered “medically necessary.” This means a healthcare provider must determine the MRI is required to diagnose or treat a medical condition, monitor progress, or guide treatment. The provider’s order specifies the reasons for the scan. The MRI must be ordered by a doctor who accepts Medicare and performed at a Medicare-approved facility. The healthcare provider typically handles the claim submission to Medicare.

If an MRI is performed during an inpatient hospital stay, it falls under Medicare Part A coverage. In such cases, the MRI cost is generally included as part of the overall inpatient treatment. Prior authorization for MRIs may be necessary in some situations.

Medicare Advantage Plan Coverage

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are legally mandated to cover at least the same services as Original Medicare Part A and Part B, including medically necessary MRIs.

While the scope of coverage is similar to Original Medicare, the specific rules and processes for obtaining an MRI can differ significantly between Medicare Advantage plans. Many plans operate with provider networks, meaning beneficiaries might need to use specific doctors and imaging facilities to receive the highest level of coverage. Some plans may also require prior authorization or a referral from a primary care physician before an MRI can be scheduled.

Individuals enrolled in a Medicare Advantage plan should contact their plan provider directly. Reviewing policy documents and confirming network participation and authorization requirements before scheduling an MRI helps ensure seamless coverage and avoid unexpected expenses. The out-of-pocket costs, such as copayments and deductibles, for MRIs also vary considerably among different Medicare Advantage plans.

Understanding Your Costs

Out-of-pocket costs for an MRI depend on whether an individual has Original Medicare or a Medicare Advantage plan. For those with Original Medicare Part B, an annual deductible applies before coverage begins. For 2025, this deductible is $257.00. After the deductible is met, Medicare Part B typically covers 80% of the Medicare-approved amount for the MRI, leaving the beneficiary responsible for the remaining 20% coinsurance.

If the MRI is performed during an inpatient hospital stay under Original Medicare Part A, a deductible of $1,676 per benefit period applies for 2025. After this deductible, Part A generally covers the full cost for the first 60 days of hospitalization. Original Medicare does not have an annual out-of-pocket maximum, meaning there is no cap on the total amount a beneficiary might pay for coinsurance and deductibles.

Medicare Advantage plans have varying cost-sharing structures, which can include copayments, coinsurance, and deductibles for MRIs. A notable difference is that Medicare Advantage plans include an annual out-of-pocket maximum, which limits the total amount beneficiaries pay for covered services in a year. For 2025, this maximum can be up to $9,350 for in-network services, though plans may set lower limits. For Original Medicare beneficiaries, supplemental insurance, such as a Medigap policy, can help cover out-of-pocket costs like deductibles, copayments, and coinsurance. Before undergoing an MRI, it is advisable to confirm potential costs with the ordering doctor, the imaging facility, and the Medicare plan to ensure clarity on financial obligations.