Medicare may cover an MRI if you meet certain criteria. This can include having an MRI ordered by a doctor who accepts Medicare.

Your MRI may be covered by Medicare, but you’ll have to meet certain criteria. The average cost of a single MRI is around $4,000. The listed cost varies based on your geographic location and by hospital system. The out-of-pocket cost for an MRI varies according to whether you have Original Medicare, a Medicare Advantage plan, or additional insurance such as Medigap.

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
  • stroke
  • torn ligaments

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% 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 $17. If the MRI happens while you’re checked into a hospital, the average cost is $9.

Without any insurance, the cost of an MRI of the brain can cost around $4,000.

Another study found the cost of a hip MRI varies widely in the state of Iowa, with a cost ranging from $485 to $4,463.

MRIs can become more expensive depending on:

  • the cost of living in your area
  • the facility you use
  • medical factors, like if a special dye is needed for your scan or if you need 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 your care while you’re in the hospital. If you undergo an MRI during a hospitalization, Medicare Part A would cover that scan if you are at a hospital that accepts Medicare.

Medicare Part B

Medicare Part B covers outpatient medical services and supplies needed to treat a health condition, excluding prescription drugs. If you have Original Medicare, Medicare Part B will be what covers 80% 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 refers to 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% of diagnostic tests like MRIs, and you’re expected to pay the other 20% 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.

Doctors order MRIs to diagnose and create treatment plans for many health conditions, including:

If your doctor says you need an MRI, they’re probably trying to confirm a diagnosis or learn 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, or a larger part of your body scanned, which is called a closed MRI.

Both procedures involve lying still for about 45 minutes at a time while a magnet creates a charged field around you and radio waves transmit information to create the scan. Doctors consider MRI a low risk procedure, but some people, such as those with implanted medical devices, may not be able to get an MRI, as it uses a strong magnetic field.

An MRI tech isn’t authorized to read your scans or provide a diagnosis. When the MRI is complete, a specialist reads the images and sends the images and their report to your doctor.

Important Medicare deadlines
  • The initial enrollment period begins around your 65th birthday: You are eligible for Medicare when you turn 65 years old. You have 3 months before your birthday, the month of your birthday, and 3 months after your birthday to sign up for Medicare. Otherwise, you will pay a penalty.
  • The general enrollment period is open from January 1 through March 31: 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.
  • The sign-up period for Medicare Part D is April 1 through June 30: If you enrolled in Medicare during general enrollment, you can add a prescription drug plan (Medicare Part D) from April through June.
  • The open enrollment period is open October 15 through December 7: During this period, 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 covers 80% 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 the cost of MRI testing, and don’t hesitate to ask for a realistic estimate based on your Medicare coverage.

Read this article in Spanish