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Does Medicare Cover Mammograms?

September 27, 2023

Does Medicare Cover Mammograms?

Women need mammograms regularly to detect breast cancer at its earliest and most curable stages. It’s often an uncomfortable process, but it’s an important way to maintain your health.

One question that Medicare beneficiaries often have is, “does Medicare pay for mammograms?” If you rely on Medicare for coverage, understanding how to use the insurance to pay for routine tests including mammograms is vital.

This guide will help you understand what coverage Medicare provides for mammograms so that you can get the care you need on a regular basis.

Let’s get started!

Does Medicare pay for mammograms?

Mammograms are recommended for all women who are 40 and older. While most Medicare recipients are age 65 and older, not all of them are. 

For example, a 35-year-old woman who has been on permanent disability and receiving Social Security for at least two years may also qualify for Medicare. That’s why it’s important to understand the full breadth of what Medicare offers for mammograms, including  those under 65.

Medicare covers mammograms under Part B (medical insurance). You can get coverage for:

  • A baseline mammogram once in your lifetime between ages 35-39
  • Screening mammograms once a year if you are 40 or older
  • Diagnostic mammograms more often than once a year, if medically necessary

As long as you use a provider that accepts Medicare assignment, you pay nothing for screening mammograms. For diagnostic mammograms, you’ll pay your annual Part B deductible (unless it’s already covered) and then 20% of the Medicare-approved cost.
 

Does Medicare cover mammograms after age 65?

As you get older, does Medicare still cover annual mammograms? The good news is that they do.

If you are over 65, like most Medicare beneficiaries, you can still get coverage for screening mammograms every year. If your doctor finds additional diagnostic mammograms to be necessary more often, you can get coverage for that as well, but you’ll pay your portion of the out-of-pocket costs under Part B.

Does Medicare cover mammograms after age 70?

Because most mammogram recommendations extend through age 69, many women wonder if Medicare will cover mammograms after you turn 70.

The good news is that they do. Turning 70 does not change your mammogram coverage. In fact, some health organizations recommend getting annual mammograms all the way through age 75.

Does Medicare cover mammograms after age 75?

If the recommendations end after age 75, does Medicare still cover mammograms for those who are older?

Medicare does cover mammograms after age 75. Breast cancer continues to be a risk to women even in their late 70s and 80s. One study found that 13% of breast cancer diagnoses happened in patients between the ages of 75 and 84. 

With that information in mind, you should continue to get a screening every year or two throughout your life.

Does Medicare cover mammograms early?

Some doctors recommend a mammogram every year, while others say you can wait two years between screenings. Regardless, Medicare will cover a mammogram at a Medicare-enrolled provider once a year at no cost to you.

Annual mammograms give you the best chance of catching a problem before it becomes serious, so don’t put it off! 

How many mammograms does Medicare cover?

There is no limit to the number of medically-necessary mammograms that Medicare will cover.
Remember that the free screening is only available once a year. If you need more mammograms than that, your doctor must certify that it’s medically necessary and then Medicare will pay 80% of the Medicare-approved cost after you pay your Part B deductible.

Also, to get Medicare coverage, you’ll need to be working with a doctor and mammogram provider that accepts assignments from Medicare. That means they agree to the Medicare-approved payment for care.

Learn more about Medicare coverage for mammograms

Mammograms may be uncomfortable, but the early detection they provide can save your life. It’s important to keep up with the health screenings available to you, and Medicare provides many of these free of cost as long as you use a Medicare-enrolled provider.
If you have more questions about Medicare coverage or would like to compare Medicare Advantage plans to find the right option for your needs, we’re here to help. Simply contact us today and we’ll help you understand your coverage and how to maximize your benefits.

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