Medicare covers mammograms at no cost to you when ordered by your doctor for screening or diagnosis

Medicare Part B covers screening mammograms — the routine X-rays used to check for breast cancer in people without symptoms — once every 12 months for women age 40 and older. If your doctor orders a diagnostic mammogram because you have symptoms or an abnormal result, Medicare covers that too. You pay nothing for the mammogram itself when you go to a facility that accepts Medicare.

The catch is that the facility must be certified by the FDA to perform mammograms. Most hospitals and imaging centers are, but it is worth confirming before your appointment. If you go to an uncertified facility, Medicare will not cover the cost, and you will owe the full bill.

If you have a Medigap or Medicare Advantage plan, your coverage may differ slightly. Medigap plans typically cover your Part B coinsurance, which means you pay nothing. Medicare Advantage plans vary — some cover mammograms with no cost-sharing, others charge a copay. Check your plan documents or call the plan directly to know what you will owe.

Key Takeaways

  • Medicare Part B covers one screening mammogram per year for women age 40 and older at no cost when ordered by your doctor.
  • Diagnostic mammograms ordered because of symptoms or abnormal results are also covered with no cost to you.
  • The facility performing the mammogram must be FDA-certified, or Medicare will not cover the service.
  • If you have a Medicare Advantage or Medigap plan, your out-of-pocket cost may differ, so check your plan details before scheduling.
  • You will need a doctor's order for the mammogram; screening ordered without a referral may not be covered.

What counts as a screening versus a diagnostic mammogram

A screening mammogram is a routine check when you have no breast symptoms or concerns. Your doctor orders it as part of preventive care. Medicare covers one per year for women age 40 and older, with no cost to you.

A diagnostic mammogram is ordered when you have a symptom — like a lump, pain, or discharge — or when a screening mammogram showed something unusual. Diagnostic mammograms take longer and may include extra images or ultrasound. Medicare covers these at no cost as well, even if you have more than one in a year.

The difference matters because some plans or facilities may handle billing differently depending on the type. When you call to schedule, tell them whether your doctor ordered it for screening or because of a specific concern. That way the facility codes it correctly and you avoid surprise bills.

How to make sure your mammogram is covered

Start by asking your primary care doctor or OB-GYN for an order. Medicare requires a doctor's order for coverage. If you schedule a mammogram on your own without a referral, Medicare may deny the claim, and you could owe the full cost.

When you call the imaging center to schedule, confirm three things: that they accept Medicare, that they are FDA-certified to perform mammograms, and what you need to bring. Ask whether they will bill Medicare directly or whether you need to pay upfront and seek reimbursement. Most facilities bill Medicare directly, but some do not.

Bring your Medicare card and any referral paperwork your doctor gave you. If you have a Medicare Advantage plan, bring that card too — some Advantage plans require you to use in-network facilities, and going out of network could mean a higher bill.

What happens if you have a Medicare Advantage plan

Medicare Advantage plans (Part C) must cover mammograms at the same rate as Original Medicare — meaning screening mammograms are covered once per year at no cost. However, the plan may require you to use an in-network facility, and you may owe a copay even though Original Medicare would cover it with no cost-sharing.

Some Advantage plans cover preventive care with zero copay, while others charge $0 to $50 per visit depending on the plan. Check your plan's summary of benefits or call the plan's customer service line to find out what you will owe. If the plan requires a referral, get one from your primary care doctor before scheduling.

If you use an out-of-network facility without permission, you may owe more or the plan may not cover it at all. Always check your plan's network list or call the plan before scheduling.

What happens if you have a Medigap plan

Medigap plans (supplemental insurance) do not order care or manage networks — they straightforward pay the coinsurance or copay that Original Medicare does not cover. Since Original Medicare covers mammograms with no cost-sharing, most Medigap plans will also cover the mammogram with no cost to you.

However, the specific coverage depends on which Medigap plan you have (Plan A, B, C, and so on). Review your Medigap policy documents, or call your Medigap insurer to confirm. If you have both Medicare and Medigap, you will typically pay nothing for a covered mammogram at an FDA-certified facility.

Mammograms and your deductible

If you have Original Medicare, mammograms do not count toward your Part B deductible. Medicare classifies them as preventive care, which means you owe nothing even if you have not met your deductible for the year.

If you have a Medicare Advantage plan, the plan's deductible rules explore instead. Some Advantage plans waive the deductible for preventive services like mammograms, while others do not. Check your plan documents or call the plan to understand how your deductible works.

What is not covered

Medicare does not cover mammograms ordered without a doctor's referral. If you schedule a screening mammogram on your own, you will owe the full cost unless your doctor later writes an order to retroactively cover it — and that is not may provide.

Medicare also does not cover 3D mammograms (tomosynthesis) in all cases. Original Medicare covers 3D mammograms only when ordered as a diagnostic test — that is, when there is a specific reason like symptoms or an abnormal screening result. Some Medicare Advantage plans may cover 3D screening mammograms, but you will need to check your plan.

Supplemental services like genetic counseling or risk assessment visits may not be covered, depending on how they are coded and billed. If your doctor recommends these services, ask whether they are covered under your plan before you go.

Frequently Asked Questions

Do I need a referral from my doctor to get a mammogram covered?

Yes. Medicare requires a doctor's order for coverage. Call your primary care doctor or OB-GYN and ask for an order. If you schedule without one, Medicare may deny the claim and you could owe the full cost.

How often does Medicare cover mammograms?

Medicare covers one screening mammogram per year for women age 40 and older. If you have symptoms or an abnormal result, your doctor can order a diagnostic mammogram, and Medicare covers those regardless of how many you have in a year.

What if the imaging center is not FDA-certified?

Medicare will not cover the mammogram if the facility is not FDA-certified. Before you schedule, ask the center whether they are certified. If they are not, you will owe the full bill. Most hospitals and major imaging centers are certified, but some smaller or newer facilities may not be.

Will I owe anything if I have a Medicare Advantage plan?

It depends on your plan. Some Advantage plans cover preventive mammograms with zero copay, while others charge a copay of $0 to $50. Check your plan documents or call the plan before scheduling to know what you will owe.

Can Medicare cover a 3D mammogram?

Original Medicare covers 3D mammograms only when ordered as a diagnostic test — meaning you have symptoms or an abnormal screening result. For routine screening, Medicare covers standard 2D mammograms. Some Medicare Advantage plans may cover 3D screening, so check your plan if you want that option.