Medicare covers mammograms with no copay or deductible when you meet the screening guidelines

Medicare Part B covers mammograms as a preventive service at no cost to you — meaning you pay nothing out of pocket, even before you meet your deductible. The coverage applies to screening mammograms (routine checks for women without symptoms) and diagnostic mammograms (imaging ordered because of a symptom or abnormal result). You must be enrolled in Medicare Part B, and your provider must be a Medicare-participating facility.

The screening guidelines differ by age. Medicare covers annual screening mammograms for women 40 and older. If you are between 40 and 49, you and your doctor can decide together whether screening makes sense for you. If you are 50 or older, Medicare covers one screening mammogram every 12 months. If you have a higher risk of breast cancer — because of family history, a genetic mutation, or a prior diagnosis — talk with your doctor about whether more frequent screening is appropriate for you.

Key Takeaways

  • Medicare Part B covers screening and diagnostic mammograms with zero copay or deductible when performed at a Medicare-participating facility.
  • You are covered for one screening mammogram every 12 months if you are 50 or older, and annual screening is available to women 40 and up.
  • If a mammogram finds something abnormal, follow-up imaging and biopsies may have different cost-sharing rules — ask your provider before the procedure.
  • You must schedule your mammogram at a facility that accepts Medicare; calling ahead to confirm participation takes one phone call and prevents billing surprises.

Where to get a Medicare-covered mammogram

You can have a mammogram at a hospital, imaging center, or doctor's office — as long as that facility participates in Medicare. Not every facility does. Before you schedule, call the facility and ask: "Do you participate in Medicare?" or "Are you a Medicare provider?" This one question prevents most billing problems.

If you need help finding a participating facility near you, use the Medicare provider search tool at Medicare.gov. Enter your zip code and search for "mammography" to see which imaging centers and hospitals in your area accept Medicare. You can also ask your primary care doctor for a referral to a facility they know participates.

What happens if the mammogram finds something abnormal

If your screening mammogram shows an area that needs closer look, your doctor will order a diagnostic mammogram or additional imaging such as an ultrasound or MRI. These follow-up tests are also covered by Medicare Part B with no copay, as long as they are medically necessary and performed at a participating facility.

If a biopsy is needed — a procedure to remove a small sample of tissue for testing — Medicare Part B covers the biopsy itself with no copay. However, if the biopsy is performed in a hospital outpatient department rather than an imaging center, you may owe a copay for the facility use. Ask your doctor where the biopsy will take place and whether facility charges will explore.

Cost-sharing if you have a Medigap or Medicare Advantage plan

If you have a Medigap policy (supplemental insurance), your Medigap plan typically covers the copays and coinsurance that Medicare does not pay. Since Medicare covers preventive mammograms with no copay, you usually owe nothing. Check your Medigap policy documents or call your plan to confirm.

If you have a Medicare Advantage plan (Part C), your coverage works differently. Most Medicare Advantage plans cover preventive mammograms with no copay, but some may require you to use in-network facilities. Call your plan before scheduling to confirm the facility is in-network and to ask whether any copay applies. Diagnostic mammograms and biopsies may have different cost-sharing rules under your plan.

What Medicare does not cover related to mammograms

Medicare covers the mammogram itself and medically necessary follow-up imaging. It does not cover supplemental screening methods such as 3D mammography (tomosynthesis) or breast ultrasound ordered as an additional screening tool for women at average risk. If your doctor recommends one of these tests as a screening tool rather than because of an abnormal finding, you may owe the full cost.

If you have a higher risk of breast cancer and your doctor believes supplemental screening is medically necessary, ask your doctor to document the medical reason. Some Medicare Advantage plans cover supplemental screening for high-risk women; Medigap does not. Your doctor can submit a request for coverage review if they believe the test is necessary.

Questions to ask your doctor before your mammogram

Before you schedule, ask your doctor: "Is this a screening or diagnostic mammogram?" This tells you whether you are covered with no copay. If it is diagnostic, ask whether any follow-up tests are already anticipated, so you understand what might happen next.

Ask: "Will this be done at a Medicare-participating facility?" Your doctor's office can tell you where they send patients for imaging. If you are scheduling on your own, always confirm Medicare participation by phone before the appointment.

If you have a Medicare Advantage plan, ask: "Is this facility in my plan's network?" This prevents a surprise bill if the facility is out-of-network.

When to contact Medicare or your plan

Call Medicare at 1-800-MEDICARE (1-800-633-4227) if you receive a bill for a screening mammogram and believe you should not owe anything. Have your Medicare card and the facility's bill in front of you. Medicare can tell you whether the facility participated and whether the test was billed correctly.

If you have a Medicare Advantage plan and disagree with a copay or denial, call the customer service number on your plan card. Ask to speak with someone about your mammogram claim. If you are not satisfied, you have the right to file a formal appeal.

Frequently Asked Questions

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

No. You can schedule a screening mammogram on your own without a doctor's order. However, it is a good idea to tell your primary care doctor that you are having one, especially if you are between 40 and 49, so your doctor knows your screening history. If the mammogram finds something abnormal, your doctor will need to order follow-up testing.

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

No. Screening and diagnostic mammograms are covered with no copay whether they are done at a hospital, imaging center, or doctor's office — as long as the facility participates in Medicare. Hospital facility charges do not explore to outpatient mammography.

What if I had a mammogram done at a non-participating facility?

You may owe the full cost. Before paying a bill, call Medicare at 1-800-MEDICARE to ask whether the facility participated. If it did not and you were not told in advance, you may be able to dispute the bill. Keep all paperwork from the facility.

Does Medicare cover breast cancer screening if I have no symptoms?

Yes. Screening mammograms for women without symptoms are covered as a preventive service with no copay. This is true whether you are 40, 50, or 70 years old. The frequency covered is one mammogram every 12 months for women 50 and older.

If my mammogram is abnormal, will all the follow-up tests be free?

Medically necessary follow-up imaging — such as diagnostic mammograms, ultrasounds, or MRIs — is covered with no copay. Biopsies are also covered. However, if the biopsy is done in a hospital outpatient setting, you may owe a facility copay. Ask your doctor where the procedure will take place before it happens.