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Does Medicare Cover Mammograms?

"Does Medicare Cover Mammograms?" text over image of mammogram reminder note

Mammograms are covered by Medicare, but to what degree? Our knowledgeable, licensed agents can help you answer this important question. Call us today at (800) 950-0608.

Just the Essentials:

  • Medicare covers a number of preventative screenings for major illnesses, such as lung cancer and breast cancer.

  • Original Medicare covers mammograms, but coverage changes by age and necessity.

  • A Medicare Advantage plan may offer more coverage for preventative services and treatments than Original Medicare.

To Prevent or Fight Cancer, Early Detection is Key

1 in 2 males and 1 in 3 women risk having some form of cancer during their lifetime. Just thinking about it is enough to provoke our deepest fears. A cancer diagnosis, or the potential of one, can cause anxiety and despair like nothing else. Your mind races. The questions are never ending.

“Is my form of cancer treatable?”

“What’s the survival rate?”

“How am I going to pay for screenings and treatments?”

That last question is a huge factor in why many individuals with cancer go untreated, or refuse potential early detection services altogether. The cost of screenings and treatment are often too high to manage for most, especially seniors. Unfortunately, without detection, most people lose their battle with the illness that is slowly taking them over.

To prevent or fight cancer, early detection is key. Most forms of cancer, including breast cancer, are beatable if found in time. In order to beat them, you need to identify them. This means scheduling regular screenings for detection, such as mammograms.

If you’re a Medicare beneficiary at risk of developing breast cancer, you may be wondering, “Does Medicare cover mammograms?” Fortunately, the answer is yes. However, there are certain provisions for coverage depending on age and necessity.

What are those provisions? Let’s find out together.

Are Mammograms Covered by Medicare?

Medicare covers a number of diagnostic and preventative screenings for cancer. This includes breast cancer screenings, such as breast cancer mammograms.

Medicare Part B, also known as the medical insurance portion of Original Medicare, is the portion which covers mammograms. How much of your breast cancer mammogram is covered by Medicare Part B depends on three different factors:

  • Your age – coverage starts for Medicare-eligible women at 35 years of age.
  • The purpose of your mammogram.
  • Whether or not your mammogram is seen as medically necessary.

Depending on those factors, Medicare Part B will cover:

  • Baseline mammograms once in a lifetime for female beneficiaries between 35 and 39 years of age.
  • Screening mammograms once a year for female beneficiaries age 40 and older.
  • Diagnostic mammograms more frequently than once a year, if deemed medically necessary.

The cost you’ll pay out of pocket depends on the purpose of the mammogram. If it’s for a breast cancer screening, you pay nothing if your provider accepts medicare assignment. If it’s a diagnostic breast cancer mammogram, you pay 20% of the Medicare-approved amount after meeting your Part B deductible.

Don’t let the potential of having to pay some amount for your mammogram keep you from getting one. Even if you’re still waiting to be approved for Medicare, you have options. The Center for Disease Control’s (CDC) National Breast and Cervical Cancer Early Detection Program provides screenings and diagnostic services at little or no cost to women with low incomes who are uninsured or underinsured.

Will Medicare Advantage Cover My Mammogram?

Medicare Advantage plans are required to cover everything that Original Medicare, Medicare Part A and Medicare Part B, covers. As a result, they cover diagnostic and screening services for major illnesses, such as cancer. This includes coverage of mammograms.

A breast cancer screening or breast cancer mammogram will be covered in the same way by Medicare Advantage as it would through Medicare Part B. The primary difference is that Medicare Advantage plans may cover other assistive services that Original Medicare does not. For instance, if you need help getting to an appointment for a mammogram, Medicare Advantage may cover your transportation costs.

I Can’t Meet the Deductible for My Mammogram Appointment. What Are My Options?

Even if you have Medicare coverage, you still may not be able to meet the deductible for your mammogram. There are options out there that can help you cover the cost. For instance, Medigap supplemental insurance can help you cover what Original Medicare or Medicare Advantage could not.

Still have questions about coverage of mammograms through Medicare? Our licensed agents have answers. Give us a call today to speak with a knowledgeable, licensed agent about coverage for mammograms through Medicare plans.

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