Most Medicare plans do not require a referral for a mammogram, but the answer depends on which type of Medicare coverage you have

Original Medicare (Part A and Part B) covers mammograms without a referral. You can go directly to any mammography facility that accepts Medicare and schedule an appointment yourself. The facility will bill Medicare, and you will pay your share of the cost — typically 20 percent of the approved amount after you meet your Part B deductible.

If you have a Medicare Advantage plan (Part C), the referral requirement depends on your specific plan. Some plans do not require a referral; others do. Your plan documents will state this clearly, or you can call the member services number on your insurance card to ask before you schedule.

If you have a Medigap supplemental policy alongside Original Medicare, you still do not need a referral — Medigap does not change how Original Medicare works. It only helps pay your out-of-pocket costs.

Key Takeaways

  • Original Medicare does not require a referral for a mammogram; you can schedule directly with any Medicare-accepting facility.
  • Medicare Advantage plans vary — some require a referral and some do not, so check your plan documents or call your plan before scheduling.
  • Medicare covers one screening mammogram per year for women 40 and older at no cost to you if you have met your deductible.
  • If your doctor suspects cancer or you have symptoms, a diagnostic mammogram may be covered differently than a routine screening.
  • Always confirm the facility accepts your specific Medicare plan before you go, because out-of-network facilities may cost you more.

How Medicare covers screening versus diagnostic mammograms

Medicare distinguishes between a screening mammogram (routine check with no symptoms) and a diagnostic mammogram (ordered because of symptoms, a lump, or abnormal results). Both are covered, but the cost and referral rules can differ.

For a screening mammogram under Original Medicare, you pay nothing if the facility is in-network and you have met your Part B deductible. Medicare covers one per year for women 40 and older. A diagnostic mammogram is also covered, but you may owe 20 percent coinsurance after your deductible.

With a Medicare Advantage plan, the copay or coinsurance for each type may be different. Some plans charge a flat copay for screening (often $0 to $50) and a different amount for diagnostic. Check your plan's schedule of benefits or call member services to know what you will owe before you go.

What to do if your doctor recommends a mammogram

If your primary care doctor or gynecologist recommends a mammogram, you do not need them to write a formal referral for Original Medicare. However, it is helpful to ask your doctor which facility they recommend, because they may have a preferred imaging center or may want to receive the results directly.

If you have a Medicare Advantage plan and your plan requires a referral, your doctor's office can submit one for you. Call your doctor's office and tell them you need a referral for a mammogram; they will send it to your plan, and your plan will tell you which facilities you can use. This usually takes a few business days.

If you are due for a routine screening and have no symptoms, you can often schedule directly without involving your doctor at all — but telling your doctor you are having one done means they can follow up on results if needed.

Finding a facility that accepts your Medicare plan

Not all mammography facilities accept all Medicare plans. Before you schedule, confirm that the facility accepts your specific coverage. For Original Medicare, most radiology centers and hospitals accept it, but always call ahead to be sure.

For Medicare Advantage, call your plan's member services line and ask for a list of in-network imaging facilities in your area. Using an out-of-network facility can cost you significantly more — sometimes hundreds of dollars — so it is worth the five-minute phone call to verify first.

You can also search the Medicare provider directory online at Medicare.gov. Enter your ZIP code and search for "mammography" to see which facilities are in-network for Original Medicare. For Advantage plans, use the search tool on your plan's website instead.

What happens after your mammogram

Results typically arrive within one to two weeks. The facility will send them to your doctor if you provided a doctor's name when you scheduled. If you had the mammogram at a hospital or large imaging center, you may also receive a copy in the mail or through a patient portal.

If the results are normal, no further action is needed. If the radiologist finds something that needs follow-up — such as a cyst or area of density — your doctor will contact you with next steps, which might be another imaging test, an ultrasound, or a biopsy. These follow-up tests are also covered by Medicare if medically necessary.

Keep copies of your mammogram results and any reports for your own records. If you change doctors or need to see a specialist, having these on hand speeds up the process.

Out-of-pocket costs you should expect

Under Original Medicare, a screening mammogram costs you nothing after you have met your Part B deductible ($240 in 2024, though this amount changes yearly). If you have not met your deductible, you will owe the full deductible amount, and then Medicare covers the rest.

A diagnostic mammogram is subject to the same deductible and 20 percent coinsurance. If the deductible is already met, you pay 20 percent of the Medicare-approved amount. If you have a Medigap policy, it may cover some or all of this coinsurance, depending on which Medigap plan you have.

With Medicare Advantage, your out-of-pocket cost depends on your plan. Some plans cover screening mammograms at no cost; others charge a copay of $0 to $50. Diagnostic mammograms may have a different copay. Check your plan documents or call member services to know your exact cost before you schedule.

Frequently Asked Questions

Can I get a mammogram at any age with Medicare?

Medicare covers screening mammograms for women 40 and older. If you are under 40, Medicare will only cover a mammogram if your doctor orders it for a specific medical reason, such as symptoms or a family history of breast cancer. In that case, it would be a diagnostic mammogram, not a screening.

What if I have a Medicare Advantage plan and cannot find an in-network facility nearby?

Call your plan's member services line and explain the situation. Many plans have an out-of-network exception process that allows you to use an out-of-network facility at in-network cost if no in-network option is reasonably available. Get approval in writing before you schedule.

Do I need a new referral every year for my annual screening?

No. If you have Original Medicare, you never need a referral. If you have a Medicare Advantage plan that requires referrals, you will need a new one each year because referrals typically expire after 12 months. Call your doctor's office in advance to request one.

What if my mammogram shows something abnormal?

Your doctor will contact you with the results and recommend next steps, which might include another mammogram, an ultrasound, or a biopsy. All of these follow-up tests are covered by Medicare if your doctor orders them as medically necessary. You will owe your usual copay or coinsurance for each test.

Can I use my Medigap policy to cover the mammogram cost?

Medigap policies cover your coinsurance and deductible, so if you have a Medigap plan, it will pay the 20 percent you would normally owe for a diagnostic mammogram. For screening mammograms, which are free under Original Medicare, Medigap has nothing to pay.