Does Medicare Pay for Mammograms After 70?
Demystify Medicare coverage for mammograms. Understand what's covered and your potential out-of-pocket costs for essential breast health.
Medicare, a health insurance program, provides health coverage for millions of Americans, particularly those aged 65 or older. Mammograms are an important preventive measure for maintaining breast health and facilitating early detection. Understanding how Medicare covers these screenings and diagnostic procedures is essential for beneficiaries.
Medicare Coverage for Screening Mammograms
Medicare Part B, which covers medical services and outpatient care, provides coverage for screening mammograms. This coverage extends to annual screening mammograms for women aged 40 and older, with no upper age limit. Individuals aged 70 and beyond continue to receive this benefit, ensuring ongoing access to preventive care.
A screening mammogram serves as a routine preventive check-up, performed when an individual has no symptoms of breast problems. Its purpose is to detect potential breast changes early, before any physical signs become apparent. For beneficiaries whose healthcare provider accepts Medicare assignment, these annual screening mammograms are covered at 100% of the Medicare-approved amount, meaning there are no out-of-pocket costs such as deductibles or coinsurance.
Medicare’s commitment to covering these preventive screenings aligns with the understanding that early detection can significantly improve health outcomes. This proactive approach helps identify breast cancer at its most treatable stages. The no-cost provision for screening mammograms aims to remove financial barriers that might prevent beneficiaries from undergoing these important annual checks.
Medicare Coverage for Diagnostic Mammograms
Diagnostic mammograms are performed to investigate specific concerns or symptoms, such as a breast lump, pain, nipple discharge, or an abnormal finding from a screening mammogram. These procedures provide a more detailed examination of a suspicious area to determine the cause of the issue. Medicare Part B covers diagnostic mammograms when a healthcare provider deems them medically necessary. Unlike screening mammograms, diagnostic mammograms are not considered a free preventive service, and beneficiaries typically incur some out-of-pocket costs.
Understanding Your Out-of-Pocket Costs
For annual screening mammograms, Original Medicare Part B covers the service in full, resulting in no out-of-pocket costs for the beneficiary, provided the provider accepts Medicare assignment. This means beneficiaries can receive these important preventive services without direct financial burden.
For diagnostic mammograms, beneficiaries face cost-sharing. The annual Medicare Part B deductible applies. In 2025, this deductible is $257. Once met, the beneficiary pays a 20% coinsurance of the Medicare-approved amount for the diagnostic service. For example, if a diagnostic mammogram has a Medicare-approved amount of $200, and the deductible has been met, the beneficiary would pay $40.
Medicare Advantage Plans (Part C), offered by private insurance companies, must cover at least everything Original Medicare Part A and Part B cover, including mammograms. While they cover screening mammograms at no cost, their cost-sharing for diagnostic mammograms may differ, often involving fixed copayments rather than a 20% coinsurance.
Medigap policies (Medicare Supplement Insurance plans) can help manage out-of-pocket expenses associated with Original Medicare. These plans, offered by private insurers, can cover costs such as the Part B deductible and the 20% coinsurance for diagnostic mammograms. The specific benefits depend on the Medigap plan selected.