Does Medicare Cover Mammograms? 

Medical conditions that affect the breast are a concern for women of all ages, but older women need to pay particular attention to breast health. According to the National Cancer Institute, the odds of developing breast cancer go up as women get older, and by age 60, older women have a 1-in-28 chance of developing breast cancer.

The key to treating breast cancer successfully is early detection. For the most part, breast cancer and other diseases of the breast that are caught in the early stages have a much higher positive outcome rate in treatment. This is why mammograms play such a vital role in protecting women’s lives.

If your doctor recommends you have a mammogram performed, and you’re eligible for Medicare, your test may be covered. 

What is a mammogram?

A mammogram is a medical imaging test that is used to obtain a detailed look at internal breast tissue. The test itself is a relatively painless, short procedure that can be performed on an outpatient basis. Most women are encouraged to begin having regular mammograms performed around the age of 40, but having a family history of breast cancer may move this timeline up to an earlier age. Only your doctor can help you to determine the right timeline for your health, so you’re encouraged to consult with a physician in order to understand your risk factors and recommendations.

How does Medicare cover mammograms?

Because female seniors are more at risk for developing breast cancer, it’s good to know whether Medicare benefits cover mammogram testing. Thankfully, Medicare insurance is available for mammogram screening. Based on your personal needs, family history, and any age, you may be scheduled for a screening. Women with a family history of breast cancer or who are predisposed to developing breast cancer due to other factors are provided with additional opportunities to receive covered screening tests.

Although Medicare coverage is intended to provide healthcare benefits for seniors, Medicare is available to Americans under the age of 65 in cases of certain disabling conditions. As such, Medicare coverage for a baseline mammogram is available for women between the ages of 35 and 39. This mammogram is meant to establish a healthy baseline to be used for comparison purposes later in life.

If you are a woman who is over the age of 40 and you have Medicare coverage, your insurance will pay for one mammogram screening once per year. Medicare coverage is available for both traditional mammogram testing and 3D mammogram imaging. If medically necessary due to a particular healthcare concern or family history of breast health concerns, Medicare benefits will cover additional mammograms as needed.

If you have Original Medicare, you’ll need to visit doctors and providers who accept assignment. If you’re enrolled in a Medicare Advantage plan, you may need to visit physicians within your plan’s network to receive coverage. 

Mammogram testing covered by Part A and Part B

When it comes to paying for mammogram testing, Medicare Part B provides benefits for outpatient procedures that include diagnostic testing and imaging. Medical appointments with doctors and specialists are also covered by Medicare Part B. This optional coverage does require that Medicare recipients meet a deductible for the year before benefits go into effect, and Part B coverage carries with it a monthly premium. Although voluntary, most people sign up for Part B when they’re first eligible for Medicare to avoid late enrollment penalties later. 

If you are hospitalized or admitted to a skilled nursing facility and a mammogram is performed as part of your inpatient treatment, Medicare Part A provides coverage instead. Medicare benefits under Part A are time-limited and will provide up to 60 days of covered care in a Medicare-participating hospital. Additional time is available at a per-day rate up to 90 days in a hospital or 100 days in a skilled nursing facility.

Medicare Advantage (MA) plans are required to include the same Part A and Part B benefits as Original Medicare. Most MA plans include additional coverage for little to no additional cost. Since MA plans are offered by private insurance companies, costs and benefits may differ. Extra benefits may include prescription drugs, vision and dental care, hearing exams, and more. 

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