What Will Medicare Cover for a Mammogram?

mammogram, medicare

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Breast cancer is one of the leading cancers in women and causes over 40,000 deaths in the U.S. per year, so it goes without saying that breast health is very important. The American Cancer Society recommends a yearly mammogram for women ages 45 to 54. If you’re 55 or older, it’s recommended that you get a mammogram every one to two years.

What Medicare covers for preventative mammograms

If you don’t have any symptoms or a history of breast cancer, Medicare Part B covers:

  • One baseline mammogram for women ages 35-39
  • One annual screening mammogram for women age 40 and older

For these preventative screenings, Medicare pays 100 percent. This means if you qualify, you won’t have to pay a copay, coinsurance, or anything toward your deductible.

Please note: Medicare does not cover preventative mammograms for men.

What Medicare covers for diagnostic mammograms

Your doctor may order a diagnostic mammogram if you have a lump or if you exhibit symptoms of breast cancer. Medicare will cover 80 percent of the cost of diagnostic mammograms, leaving you to pick up 20 percent of the cost after you’ve met your Part B deductible.

You may have as many diagnostic mammograms as your doctor deems necessary. Medicare will cover diagnostic mammograms for both men and women.

3D mammograms

The FDA approved 3-D mammograms (also called breast tomosynthesis) in 2011. This new technology has been proven to better find cancers and reduce the instances of false positives along with the emotional stress that comes with them. These 3-D mammograms provide a more detailed image of the breast tissue, and may be especially helpful for those with dense breasts or those at high risk for breast cancer.

Original Medicare (Part A and Part B) does not cover 3-D mammograms at this time. However, some Medicare Advantage plans do. If you have questions about what your plan will cover for mammography, call your Medicare plan directly.


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Find a Medicare Plan Near You!

Speak to a licensed broker who can help you look for plans.

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