How Often Does Medicare Pay for a Mammogram?
Understand how Medicare covers mammograms, including both preventive screenings and diagnostic imaging, plus what you might pay out-of-pocket.
Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. A mammogram is an X-ray imaging method used to examine breasts for early detection of breast cancer, an important health screening.
Medicare Coverage for Screening Mammograms
Medicare Part B provides coverage for screening mammograms, which are preventive services aimed at early detection when no symptoms are present. For women aged 40 and older, Medicare Part B covers one screening mammogram every 12 months. Additionally, a baseline mammogram is covered once in a lifetime for women between 35 and 39 years of age. These services are generally covered at 100% of the Medicare-approved amount.
Beneficiaries typically pay nothing for screening mammograms if their healthcare provider accepts Medicare assignment. This means there is no deductible or coinsurance applied to these preventive screenings. Medicare Advantage plans also cover screening mammograms at no charge, provided the beneficiary uses an in-network provider.
Medicare Coverage for Diagnostic Mammograms
Diagnostic mammograms are performed when a medical professional suspects breast cancer due to specific symptoms, abnormal screening results, or other medical indications. Medicare Part B covers diagnostic mammograms when medically necessary. Unlike screening mammograms, there is no set frequency limit; they can be covered as often as a doctor considers necessary to diagnose or treat a condition.
A diagnostic mammogram may be ordered if a person has a history of breast cancer, exhibits signs or symptoms of breast disease, or if a doctor believes it is medically required. This coverage applies to both males and females when medically justified.
Understanding Costs for Mammograms
The financial responsibility for mammograms under Medicare varies based on the type of service received. Screening mammograms are considered a preventive service and are typically covered at 100% of the Medicare-approved amount. This means beneficiaries usually incur no out-of-pocket costs, such as deductibles or coinsurance, for these annual or baseline screenings, assuming the provider accepts Medicare assignment.
For diagnostic mammograms, the cost structure is different. After the annual Part B deductible is met, beneficiaries are generally responsible for 20% of the Medicare-approved amount. For example, the Medicare Part B deductible for 2025 is $257. Medicare Advantage plans also cover diagnostic mammograms, but their specific cost-sharing, such as copayments or coinsurance, may vary and typically apply. Supplemental insurance plans, like Medigap, can help cover some of the out-of-pocket expenses associated with diagnostic mammograms, including coinsurance and deductibles.