Does Medicare Cover X-rays? A Breakdown of Your Costs

X-rays are a common diagnostic tool used by healthcare providers to visualize the internal structures of the body. These imaging procedures assist in diagnosing various conditions, from broken bones to lung issues. Medicare, the federal health insurance program, provides coverage for millions of Americans, primarily those aged 65 or older, certain younger individuals with disabilities, and people with End-Stage Renal Disease. Understanding how X-rays are covered under this program is an important aspect of managing healthcare expenses.

Coverage Under Medicare Part A and Part B

Medicare provides coverage for medically necessary X-rays through its different parts, depending on the setting where the service is received.

Medicare Part A (Hospital Insurance) covers X-rays performed during an inpatient hospital stay, typically as part of broader services received while admitted. Part A also covers X-rays received in a skilled nursing facility or as part of hospice care for terminally ill patients.

Medicare Part B (Medical Insurance) covers X-rays conducted in outpatient settings, including a doctor’s office, a freestanding radiology center, or a hospital outpatient department. Part B covers both the technical component (equipment and facility costs) and the professional component (radiologist’s interpretation). Common examples include X-rays to diagnose suspected fractures, pneumonia, or internal issues like foreign objects.

Out-of-Pocket Costs for X-rays

For X-rays performed during an inpatient hospital stay, costs are generally integrated into the Medicare Part A deductible and coinsurance for that inpatient period. Once the Part A deductible is met, coinsurance may apply for extended stays.

Outpatient X-rays under Medicare Part B have different cost-sharing requirements. Beneficiaries are typically responsible for the annual Part B deductible, if not already met for the year. After the deductible is satisfied, Medicare usually pays 80% of the Medicare-approved amount for the X-ray service, with the remaining 20% as the beneficiary’s coinsurance responsibility.

To manage these costs, seek care from providers who accept Medicare assignment. These providers agree to accept the Medicare-approved amount as full payment, limiting the beneficiary’s out-of-pocket expense to the 20% coinsurance. Medicare Supplement Insurance (Medigap) can also help cover some or all of these out-of-pocket expenses, including deductibles and coinsurance, for services covered by Original Medicare.

Medicare Advantage Plan Coverage

Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits. These plans, provided by private insurance companies approved by Medicare, are required by law to cover at least all services Original Medicare (Parts A and B) covers, including medically necessary X-rays.

However, these plans structure costs and access to care differently from Original Medicare. Medicare Advantage plans may have their own rules regarding deductibles, copayments, and coinsurance for X-rays, often operating with network restrictions. Beneficiaries should review their plan’s benefits guide to understand copayments, coinsurance, or prior authorization requirements for X-ray services.

Medical Necessity and Referrals

For Medicare to cover an X-ray, it must be ordered by a licensed doctor or another qualified healthcare provider. The procedure must also be considered “medically necessary,” meaning it is required to diagnose or treat a health condition and is appropriate for the patient’s medical needs.

While most diagnostic X-rays fall under these rules, certain screening X-rays, such as mammograms or lung cancer screenings, have distinct coverage rules and frequency guidelines. These are often covered even without symptoms for early detection. Patients should confirm with their provider that the X-ray is medically necessary and expected to be covered by their Medicare plan.