If you’re struggling to understand Medicare, Connie can help. Ask Connie your question, and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.
Dear Connie,
My family has a history of breast cancer. I’ve had routine mammograms and don’t want that preventative measure to stop.
However, I’m curious, does Medicare cover mammograms? And what is the rule for people with a family history or at high risk? Can I get them more frequently?
Getting ahead of cancer,
Patricia from Houston, Texas
No-cost, unbiased service
Compare all major plans and carriers
Local, licensed insurance agents with 25+ years of combined experienceDear Patricia,
Prevention is the best tool for getting ahead of breast cancer. According to the American Cancer Society, the average age of a breast cancer diagnosis in women is 62, and nearly 20% of women diagnosed are over 75. That means many people at or near Medicare age are at higher risk. You asked exactly the right question.
Yes. Medicare Part B covers mammograms. Part B is the medical insurance side of Original Medicare. According to Medicare.gov, Part B covers screening and diagnostic mammograms. Each type has its own rules for how often you can get one and what you pay out of pocket.
Once you turn 40, Medicare Part B covers one screening mammogram every 12 months. Screening mammograms check for breast tissue for cancer before any symptoms appear. They are a preventive health care service.
According to Medicare.gov, yearly screening mammograms have no cost as long as your provider accepts Medicare assignment, meaning they agree to Medicare’s approved rate. Always confirm this before your appointment to avoid a surprise bill.
Agent tip:
“Medicare Part B covers annual screening mammograms at no cost for women 40 and older. Always confirm your provider accepts Medicare assignment before your appointment. High-risk patients may qualify for more frequent screening; ask your doctor.”
A diagnostic mammogram is used when a screening result looks unusual or when you have symptoms such as a lump or nipple discharge. These are not a preventive service; they are used to diagnose a potential problem.
According to Medicare.gov, Medicare covers diagnostic mammograms as often as your doctor determines they are medically necessary. There is no strict annual limit.
The cost differs from that of a screening mammogram. After you meet your Part B deductible, you pay 20% of the Medicare-approved amount. Medicare pays the other 80%.
Medicare also covers 3D mammograms, also called tomosynthesis. According to Medicare.gov, coverage follows the same rules as standard mammograms. If your doctor orders a 3D mammogram and your provider accepts Medicare, it is covered under Part B.
Yes. If your doctor determines you are at high risk for breast cancer, you may qualify for more frequent mammograms. This includes people with:
Medicare covers additional screenings when a doctor orders them as medically necessary. Talk to your doctor about your risk level and whether more frequent imaging is right for you.
According to Medicare.gov, here is a quick overview of costs for each mammogram type:
| Type | How Often | Your Cost |
|---|---|---|
| Screening Mammogram (age 40+) | Once every 12 months | $0 (provider must accept Medicare assignment) |
| Diagnostic Mammogram | As medically necessary | 20% coinsurance after Part B deductible |
| 3D Mammogram (Tomosynthesis) | Once every 12 months if used as a screening; as often as your doctor says is medically necessary if used to diagnose a problem | $0 if used as a screening; 20% coinsurance after your Part B deductible if used for diagnosis |
According to the Centers for Medicare & Medicaid Services, Original Medicare does not have an annual out-of-pocket maximum. That means if you need multiple diagnostic mammograms or follow-up cancer treatment in one year, your costs could add up with no cap to protect you.
This is why many people with Medicare choose to add supplemental coverage. Below are three options to consider.
Medicare Advantage plans must cover everything Original Medicare covers, including mammograms. According to Medicare.gov, all Medicare Advantage plans include an annual out-of-pocket maximum, a yearly limit on what you pay for covered services. Many plans also include extra benefits like dental, vision, and hearing. Monthly premiums are often lower than Medigap, but plans use provider networks.
Medigap plans work alongside Original Medicare. According to Medicare.gov, Medigap helps pay costs that Original Medicare doesn’t cover, such as the Part B deductible and 20% coinsurance. You can see any doctor or provider that accepts Medicare, with no network restrictions.
Medicare covers mammograms for women 40 and older once a year at no cost. Diagnostic mammograms are also covered when medically necessary, but you pay 20% coinsurance after your Part B deductible is met. High-risk patients may qualify for more frequent screenings. If you have a family history of breast cancer, now is a great time to review your coverage options.
Need Help Deciding The Right Medicare Coverage For You?
No-cost, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of combined experience
Speak with a local licensed insurance agent
David Luna Co-founder and
(623) 223-8884 (TTY: 711)
M-F 9am - 5pm
Licensed Insurance AgentThere's no obligation to enroll
Medicare Part B can cover mammograms for men when a doctor orders them as medically necessary. If your doctor recommends a mammogram, Medicare’s standard cost-sharing rules apply; you pay 20% after your Part B deductible.
No referral is needed for a screening mammogram under Original Medicare. You can schedule one directly with a provider that accepts Medicare. However, some Medicare Advantage plans may require a referral or prior authorization.
Yes. If a mammogram leads to a biopsy or other follow-up procedures, Medicare Part B generally covers those services when they are medically necessary. You will pay 20% coinsurance after your deductible is met.
Medicare Part B covers one baseline mammogram for women aged 35 to 39. After age 40, Part B covers one screening mammogram every 12 months at no cost when you see a provider who accepts Medicare. No referral is needed.
Yes. Most Medigap plans help cover the 20% Part B coinsurance and deductible that apply to diagnostic mammograms. This can reduce your out-of-pocket cost to $0, depending on which Medigap plan you have. Medigap does not cover additional mammogram screenings beyond those covered by Original Medicare.
Read more by Jasmine Alberto
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2007. I am on the the Advisory Committee for Foster Grandparents, Senior Companions, and RSVP Houston. I enjoy traveling, a backyard BBQ, and volunteering in my community.
Call Now
