- Medicare will cover X-rays ordered by your physician.
- The X-ray must be medically necessary; this means it’s required to diagnose or treat an illness or injury.
- The part of Medicare that’ll cover your X-ray depends on where the test is done and your status as an inpatient or outpatient.
If your doctor orders an X-ray, there’s a good chance you’re in pain or have an illness you’re concerned about. The last thing you want to worry about is whether your Medicare plan covers this crucial test.
Rest assured that in most situations, Medicare will cover any medically necessary X-rays to diagnose an illness or assess an injury.
Keep reading to learn which parts of Medicare cover X-rays, when they’re covered, and what portion of the cost you might have to pay.
The simple answer is yes.
However, like most things under Medicare, coverage varies depending on where you get the X-ray and why you need it. This will affect what portion of the bill you might end up paying.
Coverage under Part A
In some cases, Medicare Part A will cover your X-ray, but you have to be admitted as an inpatient to the hospital when the test is done.
It’s sometimes unclear whether you’ve been admitted as an inpatient or if you’re simply under observation. Even if you stay the night in a hospital, you might be being observed as an outpatient.
Ask your doctor directly about your inpatient status when staying in the hospital and how this status will affect your Medicare coverage.
Medicare Part A covers any tests or services you need during an inpatient stay. However, if you stay in the hospital for observation rather than as an inpatient, Medicare Part B coverage may apply instead.
Coverage under Part B
Medicare Part B will usually pay for all the diagnostic and medically necessary testing your doctor orders, including X-rays. Medicare will cover your X-ray at most outpatient centers or as an outpatient service in a hospital.
Some of the places you might get an X-ray with your Medicare Part B coverage include:
- an outpatient surgery center
- a physician’s office
- the emergency room
- an urgent care center
- an inpatient hospital that offers outpatient radiology services
Coverage under Part C
However, with Medicare Advantage plans, you may elect to pay for additional coverage that could offset your share of the out-of-pocket costs you’d pay with original Medicare.
There may also be limits to your coverage with a Medicare Advantage plan that you wouldn’t have with original Medicare. For example, your coverage might be limited to facilities or healthcare providers within your plan’s network.
Coverage under Medigap
Medicare supplement insurance, or a Medigap plan, can help cover your share of any costs after getting an X-ray. This may include coinsurance, copayments, and plan deductibles.
Your doctor may order an X-ray for a number of reasons.
X-rays show the bones, tissue, and air spaces inside your body in varying shades of black, gray, and white. This helps a doctor determine the health of various parts of your body.
This test might be ordered to assess medical conditions such as:
While X-rays of the bones in your back or spine are usually covered by Medicare, they won’t be covered if they’re ordered by a chiropractor.
Medicare only covers chiropractic services for manual manipulation of the spine to treat subluxation. No other tests or services ordered by a chiropractor are covered by Medicare.
X-rays done for dental care are also not covered by original Medicare. Your Medicare Advantage plan may have dental coverage, however, if you select a plan that includes these services.
If you receive an X-ray as an inpatient, coverage would fall under Medicare Part A.
You’ll pay your Medicare Part A deductible for each benefit period. In 2020, the deductible is $1,408. Once that amount has been met, medically necessary services ordered by your doctor will be covered.
Medicare Part B will cover 80 percent of the cost of medically necessary X-rays that are ordered by your doctor and taken at an outpatient setting.
You’ll have to meet your Medicare Part B deductible before your coverage begins. In 2020, the deductible is $198. After that, you’ll only owe a copayment that’s 20 percent of the Medicare-approved cost of the service.
If you have a Medicare Advantage plan, your coverage will be the same as under original Medicare (parts A and B), but you may be responsible for different out-of-pocket costs depending on the plan you chose. You also may be restricted to certain healthcare providers or facilities that are in your plan’s network.
Check before your test
For X-rays — or any medical service — always check that your healthcare provider or the facility you go to is an approved Medicare provider. If the provider or facility doesn’t participate in Medicare, you may be stuck with the full bill, regardless of your Medicare coverage.
If you have a Medicare Advantage plan, you’ll want to confirm that the provider or facility is in your network of coverage. Otherwise, you may have to pay more — or all — of the cost.
You can always check to see if your provider or facility is covered by Medicare by clicking here.
Generally speaking, Medicare will cover any test or procedure that’s ordered by your doctor and is medically necessary. This may include:
- MRI scans
- CT scans
- other imaging studies
You may have to meet certain criteria to have your test covered. You should always check your coverage before scheduling these tests, if possible.
Imaging studies are an important tool to diagnose a number of conditions including:
You can check to see if Medicare covers a particular service or test here.
- X-rays are typically covered by Medicare, but you’ll likely have to pay a portion of the cost.
- As a general rule, Medicare covers all medically necessary tests and services ordered by a healthcare provider.
- Exceptions to Medicare coverage for X-rays include those ordered under chiropractic and dental care.
- Always check to see if your test, your healthcare provider, and the facility where you’ll have the test done are covered by Medicare or your Medicare Advantage plan before going for your X-ray.
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