Medicare will cover the cost of a mammogram annually or multiple times per year (if medically necessary). The procedure is covered under Medicare Part B. Below we discuss how often they are covered and what to expect.
Background and Overview
In modern Medicine, mammograms are the best ways doctors can screen, detect, and diagnose breast cancer. A mammogram is simply an X-ray of your breast. Generally, a technologist performs the Mammogram using a mammogram machine. The process is simple, first, you must place your chest on a plastic plate.
After, the technologist uses another plastic plate to cover your breast. Then, with some applied pressure, the machine takes an X-ray. The same procedure is applied to the sides of the chest and followed by the other breast.
In total, there are 4 X-ray results at the end of the procedure. You may feel some pain or discomfort during the process. This depends on the size of your breasts and how much pressure was applied. But this isn’t something to worry about as the procedure only lasts a few moments. The technologist passes on the results to a radiologist who relays the result to you and your physician.
The radiologist reads the X-ray by checking the changes in breast tissues for signs of breast cancer. If there are concerns, you may need to take follow up tests and refer to a specialist. If the Mammogram is healthy, the doctor may advise you to do another test in a few months. Mammograms are useful because you can compare current X-ray results with previous ones to see if there are changes.
According to a report by the National Cancer Institute, skin cancer is the most common cancer for women in the United States, followed by breast cancer. While there are only 2,300 cases of breast cancer in men annually, there are up to 230,000 cases in women. It is advised that mammogram screening tests for women should start in their mid-40s and repeated bi-annually.
When Does Medicare Cover Mammograms?
There are two classes of Mammograms. First, a screening mammogram is completed when there are no signs of breast cancer or disease. With this mammogram, it is more like a routine check. However, a diagnostic cancer test is done when you already have some unusual changes in your breast, such as a lump, discharge, or throbbing pain.
If you have enrolled in Original Medicare, your coverage includes the cost of some preventative care alongside outpatient care, some screening, and equipment. According to Medicare.gov, when it comes to mammograms, your Original Medicare covers:
- A mammogram if you are a woman within the age range of 35 and 49 years old, called a baseline test.
- A screening mammogram annually if you are a woman of 40 years or older.
- Diagnostic mammograms (you may need more than one in the year) to affirm a diagnosis.
Does Medicare Cover 3D and 2D Mammograms?
There is a traditional Mammogram and the 3D Mammogram. The 3D Mammogram, known as breast tomosynthesis, is used for a screening mammogram. It is an imaging technology that uses different X-ray tests to produce a three-dimensional image of the breast. Your Original Medicare covers the 3D Mammogram, but it may not be available in your area.
A conventional mammogram, also known as a 2D mammogram takes a black and white image of the breast to create a single image. Original Medicare covers both conventional, 2D mammograms as well as 3D mammograms.
Yes, Medicare will cover a screening mammogram once every 12 months and a diagnostic mammogram more frequently than once per if medically necessary.
Yes, Medicare will cover diagnostic mammograms multiple times per year. These exams will be covered more than once if they are deemed medically necessary by your doctor.
Medicare will cover your screening mammograms annually, regardless of your age. As long as you are covered by Medicare Part A + B. In addition, you are able to have multiple diagnostic mammograms whenever they are deemed medically necessary by your doctor.
Yes, Medicare will cover the Human Papillomavirus under Part B once every 5 years if you are between the ages of 30-65 without any symptoms of HPV
Medicare and Pap Smears
Medicare Part B will cover Pap smears and pelvic exams once every 24 months. You may be eligible for a Pap test every 12 months if you are at high risk, have a history of breast cancer, or of child-bearing and had an abnormal Pap results in int he past 36 months.
The Cost Of A Mammogram
More than 20% of women between the ages of 50 and 74 paid some out-of-pocket costs for their screening mammogram in 2015. If you have Medicare, you should not have to pay any fee for your annual mammogram screening as the Affordable Care Act removed the cost-sharing.
If you have Original Medicare Part A and B, the coverage pays for 100% of the cost of your annual screening mammogram. You don’t have to pay anything for your yearly screening mammogram. Your Medicare coverage pays 80% of the cost of a diagnostic mammogram while you pay the 20% Medicare-approved cost and Part B deductible for the test.
Which Medicare Plan Will Cover Mammogram?
While you have some coverage with Original Medicare Parts A and B, a supplemental Medicare plan such as a Medicare Advantage or Medigap plan may help cover the out-of-pocket costs associated with getting a Mammogram.
Does Medicare Advantage Cover Mammograms?
Medicare Advantage also referred to as Part C, offers equivalent coverage to Original Medicare. This means you will have the same coverage as Medicare Part B. Advantage plans will provide coverage for preventative and diagnostic screenings. Most Advantage plans will cover Mammograms at no coinsurance or out-of-pocket cost.
Medicare Advantage plans are offered through private insurance companies such as Aetna, Humana, Blue Cross, Cigna, UHC. We are contracted to offer these plans. If you have any questions please call us at 800-208-4974.
Medicare Supplement / Medigap Coverage
Medicare Supplement plans provide more flexibility than Advantage plans. You are able to see any doctors that accept Medicare, no network restrictions. With a Plan G for example, you will pay nothing other than your annual deductible.
Medicare Part B Coverage
Part B of Original Medicare covers medically necessary services and preventative care. The coverage pays for ambulance services, outpatient and inpatient mental services, some medical equipment, and some outpatient prescription drugs. Part B’s preventative and screening services cover 100% of your mammogram screening and 80% of the diagnostic mammogram.
The preventative service also includes Hepatitis B and C, HIV screening, Colorectal cancer screening, lung cancer screening, and more. You can view a full list here.
What To Do Next?
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- If you have general questions related to Medicare – or questions particular to coverage call us at (800) 208-4974
- If you are not ready to speak with us – feel free to read more about Medicare coverage here.