Medicare covers mammograms at no cost to you under Part B

Medicare Part B covers screening mammograms — the routine X-rays used to check for breast cancer in people without symptoms — at no charge. You pay nothing out of pocket, not even your deductible. This coverage applies once every 12 months for women age 40 and older, and once every two years for women age 50 and older, depending on your risk factors and what your doctor recommends.

If your mammogram finds something that needs a closer look, Medicare also covers diagnostic mammograms — the follow-up imaging done to investigate an abnormality. Diagnostic mammograms are covered the same way: no deductible, no copay.

The catch is that you must go to a facility that accepts Medicare assignment. Most hospitals and imaging centers do, but it is worth confirming before your appointment. If you go to an out-of-network facility, you may owe part of the cost.

Key Takeaways

  • Medicare Part B covers one screening mammogram per year for women age 40 and older at no cost to you.
  • Diagnostic mammograms — follow-up imaging after an abnormal result — are also fully covered with no deductible or copay.
  • You must use a facility that accepts Medicare assignment to get the no-cost benefit; call ahead to confirm.
  • If your doctor refers you for additional imaging like an ultrasound or MRI after a mammogram, Medicare coverage for those tests depends on medical necessity and your specific plan.

How to schedule a mammogram through Medicare

Call your primary care doctor's office and ask for a referral to a mammography facility. You do not need a referral to get a mammogram — Medicare does not require one — but your doctor can recommend a facility they trust and confirm whether screening or diagnostic imaging is appropriate for you.

Once you have a facility in mind, call and tell them you have Medicare Part B. Ask them to confirm they accept Medicare assignment. Give them your Medicare card number when you schedule. At your appointment, bring your Medicare card and a photo ID.

If you do not have a primary care doctor, you can call a local hospital's imaging department directly and ask to schedule a screening mammogram. They will verify your Medicare coverage over the phone.

What happens if the mammogram finds something abnormal

If the radiologist sees something that needs investigation, the facility will contact your doctor and may contact you directly. Your doctor will discuss next steps, which might include a diagnostic mammogram, ultrasound, or biopsy. Medicare covers diagnostic mammograms at no cost. Ultrasounds and biopsies are also covered if your doctor orders them as medically necessary follow-up.

You should not delay follow-up imaging because of cost concerns. The no-cost coverage applies to all of these tests when ordered by your doctor. If a facility tells you that you owe money for follow-up imaging, contact Medicare at 1-800-MEDICARE to report it.

Coverage differences between Original Medicare and Medicare Advantage

If you have Original Medicare (Part A and Part B), the coverage described above applies: screening and diagnostic mammograms at no cost. If you have a Medicare Advantage plan (Part C), your coverage is the same or better — federal law requires Advantage plans to cover mammograms with no cost-sharing — but your out-of-pocket costs may vary depending on your specific plan.

Some Medicare Advantage plans cover mammograms at in-network facilities with no copay. Others may charge a small copay. Check your plan's summary of benefits or call the plan's customer service number on the back of your card to confirm your exact coverage before scheduling.

Supplemental coverage and mammograms

If you have a Medigap (supplemental insurance) policy, it does not affect your mammogram coverage because Medicare already covers the full cost. Medigap policies are designed to cover costs that Medicare does not pay — in this case, there are no costs to cover.

If you have both Original Medicare and a Medigap policy, you will still pay nothing for a screening or diagnostic mammogram. The facility will bill Medicare first, Medicare will pay the full allowed amount, and there will be nothing left for Medigap to cover.

3D mammograms and other advanced imaging

3D mammography (tomosynthesis) is a newer technology that creates a three-dimensional image of the breast and may detect cancers that standard 2D mammograms miss. Medicare covers 3D mammograms when ordered by your doctor as a screening or diagnostic tool, at the same no-cost rate as standard mammograms.

Not all facilities offer 3D mammography yet. If your doctor recommends it and your local facility does not have it, ask for a referral to one that does. Medicare will cover the service regardless of where you go, as long as the facility accepts Medicare assignment.

What is not covered

Medicare does not cover mammograms for cosmetic or non-medical reasons. It also does not cover supplemental screening tests like thermography (thermal imaging) or other unproven breast cancer detection methods. If a facility recommends a test that is not standard breast cancer screening, ask your doctor whether it is medically necessary before proceeding — if it is not, you may owe the full cost.

Genetic testing for breast cancer risk (like BRCA testing) is a separate service. Medicare covers genetic counseling and testing when your doctor orders it based on your personal or family history, but this is different from the mammogram itself.

Frequently Asked Questions

Do I need a doctor's order to get a mammogram on Medicare?

No. Medicare does not require a referral or doctor's order for a screening mammogram. You can call a mammography facility directly and schedule one. However, having your doctor's recommendation is useful because they know your health history and can advise whether screening or diagnostic imaging is right for you.

Will I owe anything if my mammogram is done at a hospital instead of an imaging center?

No. As long as the hospital accepts Medicare assignment, you will owe nothing for a screening or diagnostic mammogram. Hospital-based imaging departments are covered the same way as standalone imaging centers. Confirm assignment when you schedule.

What if I have both Medicare and Medicaid?

Medicare is your primary payer for mammograms, and you will owe nothing under Medicare. Medicaid does not bill in this situation. If a facility tells you that you owe money, contact Medicare at 1-800-MEDICARE.

How often can I get a mammogram on Medicare?

Medicare covers one screening mammogram every 12 months for women age 40 and older. For women age 50 and older, coverage is once every two years, though your doctor may recommend more frequent screening based on your risk factors. Diagnostic mammograms (follow-up to an abnormal result) are covered whenever medically necessary.

Does Medicare cover breast ultrasound or MRI instead of a mammogram?

Ultrasound and MRI are not replacements for screening mammograms under Medicare coverage rules. However, Medicare covers these tests when your doctor orders them as follow-up to an abnormal mammogram or for other medical reasons. Your doctor will determine what imaging is appropriate for your situation.