An MRI scan is one of the most valuable diagnostic tools that doctors use to decide what kind of treatment you need. These scans can diagnose injuries and health conditions such as aneurysm, a stroke, torn ligaments, and more.
But the average cost of a single MRI is around $1,200, so you’ll want to know if it’s covered by your Medicare plan before you get one.
If you have Medicare, your MRI may be covered, but you’ll have to meet certain criteria. The out-of-pocket cost for an MRI will vary according to whether you have Original Medicare, a Medicare Advantage plan, or additional insurance such as Medigap.
This article will discuss the costs associated with an MRI if you have Medicare, and how to get the most out of your coverage.
Medicare will cover your MRI as long as the following statements are true:
- Your MRI has been prescribed or ordered by a doctor who accepts Medicare.
- The MRI has been prescribed as a diagnostic tool to determine treatment for a medical condition.
- Your MRI is performed at a hospital or imaging facility that accepts Medicare.
Under Original Medicare, you’ll be responsible for 20 percent of the cost of an MRI, unless you’ve already met your deductible.
According to Medicare.gov, the average out-of-pocket cost for an outpatient MRI scan is around $12. If the MRI happens while you’re checked into a hospital, the average cost is $6.
Without any insurance, the cost of an MRI can run over $3,000 or more. Research compiled by the Kaiser Family Foundation showed that the average cost of an MRI without insurance was $1,200, as of 2014.
MRIs can become more expensive depending on the cost of living in your area, the facility you use, and medical factors, like if a special dye is needed for your scan or if you need or anti-anxiety medication during the MRI.
Different parts of Medicare may play a part in providing coverage for your MRI.
Medicare Part A
Medicare Part A covers the care that you get in the hospital. If you undergo an MRI during a hospitalization, Medicare Part A would cover that scan.
Medicare Part B
Medicare Part B covers outpatient medical services and supplies that you need to treat a health condition, excluding prescription drugs. If you have Original Medicare, Medicare Part B will be what covers 80 percent of your MRI, if it meets the criteria listed above.
Medicare Part C (Medicare Advantage)
Medicare Part C is also called Medicare Advantage. Medicare Advantage is private insurance plans that cover what Medicare covers and sometimes more.
If you have a Medicare Advantage plan, you’ll need to contact your insurance provider directly to find out how much of the MRI cost you’ll pay.
Medicare Part D
Medicare Part D covers prescription drugs. If you need to take a drug as part of your MRI, such as an anti-anxiety medication to undergo a closed MRI, Medicare Part D might cover that cost.
Medicare Supplement (Medigap)
Medicare Supplement, also called Medigap, is private insurance that you can purchase to supplement Original Medicare. Original Medicare covers 80 percent of diagnostic tests like MRIs, and you’re expected to pay the other 20 percent of the bill, unless you’ve already met your yearly deductible.
Medigap plans may decrease the amount that you owe out of pocket for an MRI, depending on your specific policy and what sort of coverage it offers.
An MRI refers to magnetic resonance imaging scans. Unlike CT scans that use X-rays, MRIs use radio waves and magnetic fields to create an image of your internal organs and bones.
MRIs are used to diagnose and create treatment plans for aneurysms, spinal cord injuries, brain injuries, tumors, stroke and other heart conditions, multiple sclerosis, Alzheimer’s disease, bone infections, tissue damage, joint abnormalities, and countless other health conditions.
If your doctor says that you need an MRI, they’re probably trying to confirm a diagnosis or find out more about what’s causing your symptoms.
You may need to have one part of your body scanned, which is known as an extremities MRI. You may also need to have a larger part of your boy scanned, which is called a closed MRI.
Both procedures involve lying still for 45 minutes at a time while a magnet creates a charged field around you and radio waves transmit information to create the scan. According to a 2009 review of studies, the medical community agrees that MRIs are low-risk procedures.
An MRI tech isn’t authorized to read your scans or provide a diagnosis, even though you might be very anxious for their opinion. After your MRI is complete, the images will be sent to your doctor.
Important Medicare Deadlines
- Around your 65th birthday: Sign-up period. The age for Medicare eligibility is 65 years old. You have 3 months before your birthday, the month of your birthday, and 3 months after your birthday to actually sign up for Medicare.
- Jan. 1–March 31: General enrollment period. At the beginning of every year, you have the opportunity to sign up for Medicare for the first time if you didn’t do so when you first turned 65. If you sign up during general enrollment, your coverage begins July 1.
- April 1–June 30: Medicare Part D sign-up. If you enrolled in Medicare during general enrollment, you can add a prescription drug plan (Medicare Part D) April through June.
- Oct. 15–Dec. 7: Open enrollment. This is the period when you can request a change in your Medicare Advantage plan, switch between Medicare Advantage and Original Medicare, or switch Medicare Part D plan options.
Original Medicare does cover 80 percent of the cost of an MRI, as long as both the doctor who ordered it and the facility where it’s performed accept Medicare.
Alternative Medicare options, such as Medicare Advantage plans and Medigap, can bring the out-of-pocket cost of an MRI even lower.
Speak to your doctor if you have concerns about what MRI testing is going to cost, and don’t hesitate to ask for a realistic estimate based on your Medicare coverage.