What Medicare Covers for Mammograms and Breast Cancer Screening

Medicare Covers Annual Mammograms With No Out-of-Pocket Cost

Yes. Medicare Part B covers mammograms once every 12 months for women age 40 and older, with no deductible and no copay. If you are between 40 and 49, Medicare covers one baseline mammogram. If you are 50 or older, Medicare covers annual screening mammograms. The screening must take place at a facility certified by the FDA — your doctor can tell you which ones in your area are certified, or you can search the FDA's database online.

The coverage applies whether you get a standard 2D mammogram or a 3D mammogram (also called tomosynthesis). However, 3D mammograms are newer, and some Medicare Advantage plans may have different rules about them. If you have a Medicare Advantage plan instead of Original Medicare, check your plan documents or call the plan to confirm your coverage before you schedule.

Key Takeaways

Original Medicare Part B covers one screening mammogram per year for women 40 and older, with no deductible or copay at an FDA-certified facility.
If your doctor orders a diagnostic mammogram because you have symptoms or an abnormal result, that is covered separately and is not counted against your annual screening limit.
Medicare Advantage plans must cover at least what Original Medicare covers, but some plans may charge a copay or require you to use in-network facilities.
You pay nothing if the facility is in-network and participates with Medicare; if it does not, you may owe the full cost.

The Difference Between Screening and Diagnostic Mammograms

Medicare makes a distinction between two types of mammograms, and the difference matters for your costs. A screening mammogram is done when you have no symptoms and no known breast problem — it is the routine check. A diagnostic mammogram is done when your doctor suspects something is wrong, either because you have symptoms (like a lump or pain) or because a screening mammogram found something unusual.

Medicare covers both, but they are billed separately. Your annual screening mammogram is free. If that screening finds something and your doctor orders a diagnostic mammogram to investigate further, that diagnostic mammogram is also covered at no cost to you — and it does not count against your one screening per year. This means you could have a screening mammogram in January, get a diagnostic follow-up in February, and still be covered for another screening mammogram in December.

What You Pay at the Facility

If you have Original Medicare and go to an FDA-certified facility that accepts Medicare, you pay nothing for a screening mammogram. The facility bills Medicare directly, and Medicare pays its share. You do not owe a deductible, copay, or coinsurance.

If you have a Medicare Advantage plan, your costs depend on your specific plan. Most Advantage plans cover mammograms with no copay, but some charge a copay of $10 to $50 or require you to use in-network providers. A few plans may require prior authorization before you schedule. Call your plan or check your plan documents before you book your appointment.

If you go to a facility that does not accept Medicare or is not certified by the FDA, Medicare will not pay, and you will owe the full cost. Always confirm the facility is Medicare-certified before you go.

How to Find a Medicare-Certified Mammography Facility

The FDA maintains a searchable database of certified mammography facilities. You can search by state and city at the FDA's website. Your primary care doctor can also give you a list of certified facilities in your area that accept Medicare. Many hospitals, imaging centers, and breast health clinics are certified.

When you call to schedule, tell the facility you have Medicare and ask them to confirm they accept it. This takes 30 seconds and prevents a billing surprise later. If the facility says they do not accept Medicare, ask for a referral to one that does.

What Happens If Your Mammogram Finds Something

If your screening mammogram shows an abnormality, your doctor will order a diagnostic mammogram or other imaging (like an ultrasound or MRI) to investigate. All of these follow-up tests are covered by Medicare at no cost to you if they are medically necessary — meaning your doctor has documented a reason for them.

If a biopsy is needed, that is also covered. The key is that your doctor must order it based on the mammogram findings. You do not need to worry about whether a follow-up test will be covered; if your doctor thinks you need it, Medicare will pay for it.

Medicare Advantage Plans and Mammogram Coverage

All Medicare Advantage plans must cover at least what Original Medicare covers — one screening mammogram per year for women 40 and older, at no cost. However, Advantage plans can add their own rules. Some plans cover mammograms with no copay. Others charge a copay of $10 to $50. Some require you to use in-network providers or get prior authorization.

A few Advantage plans offer additional coverage, such as covering 3D mammograms or covering more frequent screening for women at high risk. Check your plan's summary of coverage or call the plan directly to learn what your specific plan covers. The plan's customer service number is on your insurance card.

Frequently Asked Questions

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

No. You can schedule a screening mammogram on your own without a doctor's referral. However, if you want your primary care doctor to know about the results, you can ask the facility to send a report to your doctor's office. Some women prefer to discuss screening with their doctor first, especially if they have a family history of breast cancer.

What if I am under 40?

Original Medicare does not cover mammograms for women under 40. If you are under 40 and your doctor thinks you need a mammogram because of symptoms or family history, you would pay out of pocket unless you have a Medicare Advantage plan that covers it. Talk to your doctor about whether screening is right for you.

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

Medicare covers ultrasound or MRI only if your doctor orders it for a specific medical reason — for example, to follow up on an abnormal mammogram or to evaluate symptoms. Routine screening with ultrasound or MRI alone is not covered. Your doctor can tell you whether these tests are medically necessary in your case.

What if the facility bills me after Medicare pays?

If you went to a Medicare-certified facility and the facility bills you for a screening mammogram, contact Medicare at 1-800-MEDICARE to report it. Facilities that accept Medicare are not allowed to bill you for covered services. Keep your explanation of benefits from Medicare as proof of what was covered.

Does my Medigap plan help pay for mammograms?

Medigap plans do not need to cover mammograms because Medicare already covers them with no copay. However, if you have a Medigap plan and you go to a facility that does not accept Medicare, your Medigap plan may help pay the bill. Always use a Medicare-certified facility to avoid this situation.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.