Medicare covers mammograms after age 75, but the rules change
Medicare Part B covers screening mammograms for women age 40 and older at no cost to you — no copay, coinsurance, or deductible. After age 75, coverage does not stop automatically. However, your doctor's recommendation matters more at this age, and Medicare will not pay for routine screening if your doctor documents that you are not a good candidate based on your health and life expectancy.
The practical difference: before age 75, Medicare assumes screening is appropriate. After 75, Medicare requires your doctor to order the mammogram as medically necessary for your specific situation. If your doctor does not order one, Medicare will not cover it as a screening test. If your doctor does order one and it is documented as screening, Medicare pays.
Diagnostic mammograms — ordered because you have symptoms or an abnormal finding — are covered at any age if your doctor orders them, regardless of what your doctor thinks about screening.
Key Takeaways
- Medicare Part B covers screening mammograms for women over 75 if your doctor orders them as medically necessary for you.
- After 75, your doctor must document why screening is appropriate for your health status; Medicare will not pay for routine screening without a doctor's order.
- Diagnostic mammograms ordered because of symptoms or abnormal findings are covered at any age.
- You pay nothing out of pocket for a covered mammogram — no deductible, copay, or coinsurance.
- If your doctor recommends against screening due to age or health, Medicare will not cover a screening mammogram you request on your own.
How Medicare decides coverage after age 75
Medicare's coverage rule is the same at any age: the test must be medically necessary. Before age 75, Medicare assumes screening mammograms are medically necessary for all women. After 75, Medicare shifts the burden to your doctor — your doctor must document that screening is appropriate for you given your age, health conditions, and life expectancy.
This does not mean Medicare stops covering mammograms. It means your doctor has to make the case in writing. If your doctor documents that screening mammography is medically necessary — for example, because you are in good health, have no serious chronic conditions, and screening could detect cancer early enough to treat — Medicare will pay. If your doctor documents that screening is not appropriate — for example, because you have advanced dementia, multiple serious illnesses, or a life expectancy of less than five years — Medicare will not pay for a screening mammogram.
The key distinction: screening mammograms look for cancer in women without symptoms. Diagnostic mammograms are ordered because you have a symptom, a lump, pain, or an abnormal finding on a prior test. Diagnostic mammograms are covered at any age if your doctor orders them, because they are not about age-based screening — they are about investigating a specific concern.
What you need to do before your appointment
Call your doctor and ask whether they recommend a screening mammogram for you. Be direct: explain that you are over 75 and want to know whether they think screening is appropriate for your health. Your doctor will either recommend it or advise against it based on your medical history, current health, and their clinical judgment.
If your doctor recommends screening, ask them to document it in your chart before you schedule the mammogram. You do not need to do anything else — your doctor's order is what Medicare needs. When you call the imaging center to schedule, tell them you have Medicare and ask them to confirm they accept Medicare before you book.
If your doctor advises against screening, Medicare will not cover a screening mammogram you arrange on your own. You can still have one done, but you would pay the full cost out of pocket. If you disagree with your doctor's recommendation, you can seek a second opinion from another doctor.
What happens if you have symptoms or an abnormal finding
If you have breast pain, a lump, nipple discharge, or any other symptom, your doctor will order a diagnostic mammogram. Medicare covers this at any age, with no age limit and no question about whether screening is appropriate. Your age does not factor in — the symptom does.
Similarly, if you had a prior mammogram (at any facility, not just Medicare-covered ones) that showed something unusual, and your doctor orders a follow-up mammogram to investigate, Medicare covers that follow-up. Again, your age does not matter. The reason for the test is what determines coverage.
Cost and what Medicare pays
If your doctor orders a screening mammogram and Medicare covers it, you pay nothing. Medicare Part B covers the full cost — no deductible, no copay, no coinsurance. The imaging center bills Medicare directly.
If you have a Medigap or Medicare Advantage plan, your coverage may vary slightly, but most plans follow Medicare's rules. Check your plan documents or call your plan to confirm before your appointment.
If your doctor does not recommend screening and you have a mammogram anyway, you are responsible for the full bill. Costs vary by location and facility, but screening mammograms typically range from $100 to $300 out of pocket.
Where to get a mammogram
Any imaging center, hospital, or clinic that accepts Medicare can provide your mammogram. Call ahead and confirm they accept Medicare before you schedule. Ask whether they are in-network for your Medicare Advantage plan if you have one.
You do not need a referral from Medicare, but you do need an order from your doctor. When you call to schedule, have your doctor's order number or ask your doctor's office to send it to the imaging center directly.
If you do not have a primary care doctor, you can see a gynecologist or any other doctor to discuss whether screening is appropriate for you. That doctor can then order the mammogram.
What to know about screening recommendations at this age
Major medical organizations have different guidance on screening mammograms after age 75. The American Cancer Society recommends that women with a life expectancy of 10 or more years continue screening. The U.S. Preventive Services Task Force says there is not enough evidence to recommend for or against screening in women 75 and older. Your own doctor's judgment about your health is what matters for Medicare coverage, not what national guidelines say.
This means two women both age 80 might have different coverage: one whose doctor recommends screening will have Medicare cover it, and another whose doctor advises against it will not. Both decisions are medically reasonable. Medicare's rule is that your doctor decides whether it is appropriate for you.
Frequently Asked Questions
Does Medicare automatically stop covering mammograms at age 75?
No. Medicare covers screening mammograms after 75 if your doctor orders them as medically necessary for you. Coverage does not stop at any age — the requirement is that your doctor must document why screening is appropriate for your specific health situation.
What if my doctor says I should not have screening mammograms anymore?
If your doctor advises against screening based on your health, Medicare will not cover a screening mammogram. You can still have one done privately and pay out of pocket, or you can seek a second opinion from another doctor.
Are diagnostic mammograms covered after 75?
Yes, without any age limit. If you have symptoms or an abnormal finding and your doctor orders a diagnostic mammogram, Medicare covers it at any age. Age does not affect coverage for diagnostic tests.
Do I need a referral from Medicare to get a mammogram?
No. You need an order from your doctor, but not a referral from Medicare. Call your doctor, ask whether they recommend screening, and if they do, they can send the order directly to the imaging center.
What if I have a Medicare Advantage plan instead of Original Medicare?
Medicare Advantage plans must cover at least what Original Medicare covers. Most follow the same rules: screening mammograms are covered if your doctor orders them. Check your plan documents or call your plan to confirm coverage before your appointment.