Does Medicare Cover an MRI? 

These days, MRIs or Magnetic Resonance Imaging scans, are commonly used to help physicians make more accurate diagnoses. Your doctor can use an MRI to “see” inside your body, to view your organs or skeletal system without making an incision. 

An MRI scan gives medical professionals the ability to diagnose many diseases and conditions such as:

  • Brain disease, tumors, injury, dementia, stroke
  • Injuries from falls or playing sports
  • Musculoskeletal problems
  • Ear, nose, and throat problems
  • Soft tissue conditions
  • Vascular abnormalities like aneurysm, etc.
  • Spinal conditions

When you undergo an MRI scan, you lie down on a table that slides into a tube that is surrounded by magnets. These magnets work together with radio waves to produce images of your body on the inside. The radio waves make hydrogen atoms in the body move a bit and when they go back into place, they produce a signal that the magnets can pick up and convert into images. 

MRI scans are valuable diagnostic tools that can save lives, but they can be expensive if you don’t have insurance coverage. Fortunately, your Medicare benefits may help you pay for part of the expense if your doctor orders one. 

Do Medicare benefits cover MRIs? 

Medicare categorizes MRI, CT, and PET scans; EKGs, and X-rays all as diagnostic non-laboratory tests. Original Medicare Part B covers a percentage of the cost for these types of tests when your health care provider or physician orders them to treat a medical issue, and you meet the following criteria:

  • The MRI is ordered as treatment for a medical issue. 
  • Your prescribing physician accepts Medicare assignment. 
  • The medical facility where the MRI takes place accepts Medicare assignment. 

Medicare Part B pays 80 percent of the final approved cost for MRIs that are done in a physician’s office or independent testing facility, and you pay the remaining 20 percent after you have covered your Part B annual deductible. 

If you have diagnostic non-laboratory tests done in an outpatient hospital setting, you pay an additional copayment based on what the facility charges. 

If your doctor orders an MRI while you are in a Medicare-affiliated hospital as an inpatient, Medicare Part A covers the cost after you have paid your Part A deductible for the current benefit period. 

Do Medicare Advantage plans cover MRIs? 

If you have Medicare Advantage as an alternative to Original Medicare, you are guaranteed to at least get the same benefits as Parts A and B provide. This means you have coverage for diagnostic non-laboratory tests like MRIs if you meet the necessary criteria. 

However, depending on the type of Medicare Advantage plan you have, your private insurance provider may require that you use specific health care providers, physicians, medical facilities, and hospitals. Many plans have a unique network of providers that they ask beneficiaries to use. 

Again, depending on your plan, you may not get your coverage if you use providers outside the network, so ask a plan representative if you aren’t sure about the network details. Your out-of-pocket costs for your MRI are based on what your plan charges for coinsurance, copayments, and deductibles. 

How much does an MRI cost without Medicare insurance? 

Your out-of-pocket cost for an MRI without insurance coverage depends on what type of procedure you have and where you have it done. In the United States, an MRI typically ranges between $375.00 and $2,850.00 – with the national average at $1,325.00. 

The national average price range for MRIs according to the procedure type are:

  • General: $400.00 to $5,700.00 
  • Brain: $1,600.000 to $8,400.00 
  • Cardiac: $430.00 to $6,500.00 
  • Cervical spine: $1,400.00 to $7,600.00 
  • Bone: $410.00 to $2,100.00

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