Does Medicare Pay for a Mammogram?
Navigate Medicare's mammogram coverage, understanding your benefits, costs, and how to ensure access to this crucial preventative care.
Mammograms serve as a significant tool in maintaining breast health, allowing for the early detection of potential concerns. Medicare, a federal health insurance program, supports beneficiaries by covering various healthcare services. This support includes important preventive screenings, such as mammograms, which contribute to overall wellness.
Medicare Coverage for Mammograms
Medicare Part B, which covers medical insurance, includes mammograms as part of its preventive and diagnostic services. There are two primary types of mammograms covered: screening and diagnostic.
Screening mammograms are performed regularly to check for breast cancer when no symptoms are present. Medicare Part B covers one baseline mammogram for women between the ages of 35 and 39. For women aged 40 and older, Medicare covers one annual screening mammogram every 12 months.
Diagnostic mammograms, conversely, are performed when a person has symptoms, an abnormal finding from a screening mammogram, or a history of breast cancer. These are used to investigate a specific area of concern. Medicare covers diagnostic mammograms when deemed medically necessary by a healthcare provider, and there is no limit on how many can be covered if required.
Understanding Your Costs
The out-of-pocket costs for mammograms under Original Medicare (Parts A and B) vary depending on the type of mammogram received.
For screening mammograms, beneficiaries typically pay nothing if the healthcare provider accepts Medicare assignment. No Part B deductible or coinsurance applies for these preventive services.
For diagnostic mammograms, the cost structure is different. After meeting the annual Part B deductible ($257 in 2025), beneficiaries are generally responsible for 20% of the Medicare-approved amount for the service. This coinsurance applies because diagnostic mammograms are considered a medical service to investigate a specific condition.
Medicare Advantage Plan Coverage
Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. By law, these plans must cover at least all services Original Medicare Part A and Part B cover, including both screening and diagnostic mammograms.
While coverage is similar, specific costs like copayments, coinsurance, and deductibles can differ from Original Medicare. Medicare Advantage Plans often have their own provider networks, and using in-network providers may reduce costs. Review your plan’s benefits, network rules, and prior authorization requirements to understand potential out-of-pocket expenses.
Finding a Covered Provider and What to Expect
To find a healthcare provider or facility that accepts Medicare for mammograms, use the Care Compare tool on Medicare.gov. This tool allows users to search for professionals and facilities in their area. Always confirm the provider accepts Medicare assignment when scheduling an appointment.
During a mammogram appointment, images are taken to assess breast health. A screening mammogram usually takes about 15 to 30 minutes, while a diagnostic mammogram may take longer. If a screening mammogram indicates an abnormality, additional diagnostic images or an ultrasound may be requested, which Medicare covers if medically necessary.