Yearly mammograms are an important screening tool in the early detection of breast cancer.

If you’re covered by Medicare Part B or a Medicare Advantage plan, both screening and diagnostic mammograms are covered under your plan. However, there may be different coverage levels and out-of-pocket costs depending on your plan and medical situation.

In this article, we’ll explore when Medicare covers mammograms, how much you’ll pay for a mammogram, and which Medicare plan is best if you want coverage for mammograms.

If you have Medicare Part B or a Medicare Advantage plan, you may want to know how often Medicare pays for mammograms. With Medicare, you’re covered for:

  • one mammogram as a baseline test if you’re a woman between the ages of 35 and 49
  • one screening mammogram every 12 months if you’re a woman ages 40 years or older
  • one or more diagnostic mammograms, if necessary, to diagnose a medical condition, such as breast cancer

With your Medicare coverage, both conventional and 3-D mammogram costs are covered. However, not every provider offers 3-D mammograms yet. Your doctor will discuss which types of mammogram tests are most readily available to you.

One recent study found that roughly 23 percent of women report having to pay some sort of out-of-pocket costs for a mammogram. If you have Medicare and want to know how much a mammogram will cost, you should first understand what Medicare will cover.

If you have Medicare Part B or Medicare Advantage, coverage for mammograms includes:

  • 100 percent of yearly screening mammogram costs
  • 80 percent of necessary diagnostic mammogram costs

Medicare beneficiaries pay nothing for yearly mammogram screenings. However, there may be some out-of-pocket costs for diagnostic mammograms. These costs generally include any premiums and deductibles owed, plus a coinsurance of 20 percent of the Medicare-approved costs for this test.

Having to pay out-of-pocket medical costs can greatly affect the likelihood someone will seek medical care.

One study found that when the Affordable Care Act eliminated cost sharing for mammogram screenings, more women received mammograms during their recommended screening periods.

If you’re in need of a mammogram but haven’t yet been approved for Medicare, you may be eligible for free or low-cost breast cancer screenings while you wait.

If you’re reaching the recommended age for a mammogram in 2020, it’s important to make sure that you have medical insurance that’ll cover this important test. Let’s look at which Medicare plans are best for mammogram coverage.

Part B

Medicare Part B, also known as medical insurance, covers necessary diagnostic and treatment services. Both screening and diagnostic mammograms are covered by Medicare Part B, which makes this a necessary Medicare option if you want to have this test covered.

Part B also covers medical transportation costs, which may be helpful if you need transportation to your mammogram appointment.

Part C

Medicare Part C, also known as Medicare Advantage, is a private insurance option that replaces original Medicare. A Medicare Advantage plan will automatically provide Medicare Part B coverage, meaning that your mammogram costs will be covered the same as if you had Medicare Part B.

Part C plans also cover Part A, Part D, and certain additional types of health coverage.

Other Medicare plans

Medicare Part A

Medicare Part A, also known as hospital insurance, covers any hospital services related to emergency room, inpatient, and outpatient care. Part A also covers home healthcare, nursing facility care, and hospice care. Mammogram costs aren’t included under Part A.

Medicare Part D

Medicare Part D, also known as prescription drug coverage, is an add-on to original Medicare that helps with prescription drug costs. Part D doesn’t cover mammogram costs, but it may help cover the costs associated with breast cancer medications.

Medicare supplement (Medigap)

Medigap is a supplemental insurance option for original Medicare recipients that can help lower Medicare plan costs. If you have original Medicare and are looking for help with mammogram costs, such as deductibles and coinsurance, Medigap may be an option for you.

A mammogram, otherwise known as a mammography, is a type of X-ray that’s used to detect or diagnose breast cancer. Mammograms are generally scheduled yearly for women ages 50 and older to help with the early detection of this disease.

During a mammogram, you’ll be asked to undress from the waist up to allow the machine full access to the breasts. Each breast will be placed between two specialized camera plates on the mammography machine and compressed for imaging.

While the compression lasts no longer than a few seconds each time, you may notice some pressure, discomfort, or pain. Mammograms generally take no longer than 20 minutes to perform.

If you’re due for a mammogram, there are three main types of mammography to choose from:

  • Conventional mammogram. A conventional mammogram takes 2-D black and white film images of the breast. During this test, the doctor can view the images as they are produced to look for any lumps, deposits, or other areas of concern.
  • Digital mammogram. Like a conventional mammogram, a digital mammogram takes 2-D black and white images of the breast. However, digital mammogram images are entered directly into a computer, allowing the doctor to zoom, enhance, and otherwise inspect the images with more accuracy.
  • 3-D mammogram. A 3-D mammogram takes multiple pictures during the test to produce a comprehensive 3-D view of the breast tissue. This type of mammogram, also known as 3-D tomosynthesis mammography, has been shown to improve the diagnosis of cancer in dense breast tissues.

A mammogram can help to detect both cancerous and noncancerous tissues in the breast, and it’s a crucial tool in the early detection of breast cancer.

mammogram screening recommendations

Breast cancer screening recommendations vary among individuals based on risk, age, and personal preference.

For those with an average risk of breast cancer:

  • between the ages of 40–49, mammogram screening is a personal choice that should be based on weighing the risks and benefits of the test
  • between the ages of 50–74, you should be scheduling yearly or biennial mammogram screenings
  • with Medicare, your yearly mammogram screenings will be 100 percent covered starting at age 40

For those with an increased risk of breast cancer:

  • yearly mammogram screening is recommended starting at age 40 for all women who are at an increased risk of breast cancer
  • with Medicare, your yearly mammogram screenings will be 100 percent covered starting at age 40, with one baseline mammogram covered from age 35–39

If you’re a Medicare beneficiary and have an upcoming mammogram, this test may be covered under your plan. Medicare Part B and Medicare Advantage plans both cover 100 percent of yearly screening mammogram costs, and 20 percent of diagnostic mammogram costs.

If you have other costs associated with your plan, such as a deductible, you may have to pay this amount out-of-pocket before Medicare will cover your diagnostic mammogram testing.

Breast cancer screening recommendations begin as early as 40, depending on your breast cancer risk. Speak with your doctor today to determine when to schedule your first or next mammogram.