Medicare covers mammograms with no out-of-pocket cost for preventive screening

Medicare Part B covers mammograms at no cost to you when you get them for screening purposes — meaning to check for breast cancer before you have symptoms. You pay nothing for the mammogram itself, and Medicare pays the provider directly. This applies whether you have Original Medicare or a Medicare Advantage plan, though Advantage plans may have different rules about where you can go.

The coverage applies to women age 40 and older. Medicare covers one screening mammogram every 12 months for all women in this age group. If your doctor orders additional imaging because something showed up on the first mammogram, that follow-up imaging is also covered at no cost.

The key word is screening. If you have symptoms — like a lump, pain, or discharge — your doctor may order a diagnostic mammogram instead. Diagnostic mammograms are also covered by Medicare Part B, but the rules are slightly different because they are ordered to investigate a specific concern rather than to screen a healthy population.

Key Takeaways

  • Medicare Part B covers one screening mammogram per year at no cost if you are age 40 or older.
  • You must go to a Medicare-approved facility; call ahead to confirm the location accepts Medicare before you schedule.
  • Diagnostic mammograms ordered because of symptoms are also covered, but you should ask your doctor whether the visit is for screening or diagnosis.
  • If you have a Medicare Advantage plan, check your plan documents or call the plan to confirm coverage and any facility restrictions.
  • You are responsible for any costs if you go to a facility that does not accept Medicare.

Where to get a covered mammogram

You must go to a Medicare-approved facility for the mammogram to be covered at no cost. This includes hospitals, imaging centers, and some doctor's offices that have the equipment and meet Medicare standards. Not every facility that offers mammograms is Medicare-approved, so you need to check before you schedule.

Call the facility directly and ask: "Do you accept Medicare for screening mammograms?" If they say yes, ask whether you need a referral from your doctor. Most screening mammograms do not require a referral — you can call and schedule on your own. Write down the name of the person who confirms this, in case there is confusion when you arrive.

You can also search for Medicare-approved mammography facilities on the Centers for Medicare & Medicaid Services (CMS) website, or call 1-800-MEDICARE to ask for locations near you. The phone line can tell you which facilities in your area are approved and whether they have current openings.

The difference between screening and diagnostic mammograms

A screening mammogram is done when you have no symptoms and no known breast problems. It is the routine check that Medicare covers once per year at no cost. You typically schedule this yourself or your doctor may recommend it during a regular visit.

A diagnostic mammogram is ordered when you have a symptom — a lump, pain, thickening, nipple discharge, or an abnormal finding on a previous mammogram. Your doctor orders this one specifically to investigate. Medicare covers diagnostic mammograms, but because they are ordered for a medical reason rather than routine screening, the billing may be different. You should still pay nothing out of pocket, but the facility may bill it differently to Medicare.

When you call to schedule, tell the scheduler whether your doctor ordered this for screening or because of a specific concern. If you are unsure, ask your doctor's office. This helps the facility bill correctly and ensures you understand what to expect.

What happens if you have a Medicare Advantage plan

Medicare Advantage plans (also called Part C) must cover the same preventive services as Original Medicare, including screening mammograms at no cost. However, Advantage plans can add their own rules about which facilities you can use and whether you need a referral.

Before you schedule, call your Advantage plan and ask: "What is my cost for a screening mammogram, and which facilities can I go to?" Some plans require you to use in-network providers, and going out of network may cost you money. A few plans may require a referral from your primary care doctor even though Original Medicare does not.

Keep your plan's member handbook or look it up online — it will list which imaging centers are in your network. If your preferred facility is not listed, ask your plan whether they can add it or whether you can go out of network without a penalty for preventive care.

What to bring and what to expect

Bring your Medicare card and a photo ID when you go for your mammogram. The facility will ask for these to confirm your coverage. If you have a Medicare Advantage plan, bring that card instead — it serves as proof of your Medicare coverage.

Arrive 10 to 15 minutes early to allow time for check-in. The facility will ask about your medical history, whether you have had mammograms before, and whether you have any breast symptoms. Answer honestly — this information helps the technician know what to look for.

The mammogram itself takes about 20 minutes. You will be asked to undress from the waist up and stand in front of the machine. The technician will position your breast and take images from different angles. It can be uncomfortable but should not be painful. If you have pain, tell the technician to stop.

When to ask your doctor about mammograms

If you are age 40 to 49, talk to your doctor about whether screening mammograms are right for you. Medicare covers them, but medical organizations have different recommendations about when to start screening. Your doctor can discuss your personal risk based on your family history, previous breast biopsies, or other factors.

If you are age 50 and older, most organizations recommend screening mammograms every one to two years. Medicare covers one per year, so you can get one annually if you and your doctor think that is best.

If you have symptoms — a lump, pain, dimpling, or nipple discharge — do not wait for your annual screening. Call your doctor right away and describe what you noticed. Your doctor can order a diagnostic mammogram, which Medicare also covers.

If you do not have Medicare yet

If you are not yet enrolled in Medicare but are turning 65, you can enroll during your Initial Enrollment Period, which starts three months before the month you turn 65. Mammogram coverage begins the day your Medicare coverage starts.

If you are under 65 and have Medicare because of disability or end-stage renal disease, the same mammogram coverage applies — one screening mammogram per year at no cost.

Frequently Asked Questions

Do I need a doctor's referral to get a screening mammogram?

No. For a routine screening mammogram, you can call a Medicare-approved facility and schedule directly without a referral. However, some Medicare Advantage plans may require a referral, so check with your plan first. If your doctor orders a diagnostic mammogram because of symptoms, that is already a referral.

What if the mammogram shows something abnormal?

If the radiologist sees something that needs follow-up, they will contact your doctor, and your doctor will call you. Any additional imaging or biopsy ordered by your doctor is also covered by Medicare at no cost. Do not delay calling your doctor if you are told to follow up — early detection is important.

Can I get more than one mammogram per year if I want to?

Medicare covers one screening mammogram per year. If your doctor orders additional mammograms or other imaging because of symptoms or abnormal findings, those are covered as diagnostic services. Talk to your doctor about whether more frequent screening is medically necessary for you.

What if I go to a facility that does not accept Medicare?

If you go to a non-approved facility, Medicare will not pay, and you will be responsible for the full cost. Always confirm the facility accepts Medicare before you schedule. If you are unsure, call 1-800-MEDICARE to verify.

Does my cost change if I have Part B deductible or coinsurance?

No. Preventive services like screening mammograms are covered at no cost even if you have not met your Part B deductible. You pay nothing. Diagnostic mammograms may be subject to your deductible and coinsurance, so ask the facility about your cost before the appointment if your doctor ordered it for a specific reason.