Medicare covers most x-rays, but what you pay depends on which part of Medicare you have and where you get the x-ray done

If you have Original Medicare (Part A and Part B), x-rays are covered as long as your doctor orders them for a medical reason. Medicare Part B pays 80 percent of the cost after you meet your yearly deductible. You pay the remaining 20 percent, plus any amount above what Medicare considers the standard charge for that x-ray in your area.

If you have a Medicare Advantage plan (Part C), your coverage and out-of-pocket costs work differently. Each plan sets its own rules about x-rays — some charge a copay (a fixed amount like $25), others use coinsurance (a percentage of the cost), and some cover x-rays with no cost to you. You need to check your plan's coverage details or call the plan directly to know what you will pay.

X-rays ordered in a hospital emergency room, ordered during an inpatient hospital stay, or done at an outpatient hospital facility may be covered under Part A instead of Part B, which changes what you owe. The location where you get the x-ray matters as much as the type of x-ray itself.

Key Takeaways

  • Original Medicare Part B covers x-rays ordered by your doctor, and you pay 20 percent of the cost after your deductible.
  • Medicare Advantage plans cover x-rays but set their own copays or coinsurance amounts, which you must check in your plan documents or by calling the plan.
  • X-rays done at a hospital outpatient department or emergency room may be covered under Part A with different cost-sharing than Part B.
  • Your doctor's office, an urgent care center, and a hospital imaging center may all charge different amounts for the same x-ray, even when Medicare covers it.

How Original Medicare Part B covers x-rays

Under Original Medicare Part B, your doctor or other healthcare provider must order the x-ray for a medical reason — to diagnose or monitor a condition. Routine x-rays for screening purposes (like a chest x-ray with no symptoms) are usually not covered. Once your doctor orders it, the x-ray is covered whether you get it at your doctor's office, an urgent care center, or an outpatient imaging facility.

You pay your Part B deductible first (the amount changes each year). After you meet the deductible, Medicare pays 80 percent and you pay 20 percent. The 20 percent is calculated on the amount Medicare approves, not the amount the facility charges. If a facility charges more than Medicare's approved amount, you may owe the difference — this is called balance billing. Facilities that accept Medicare assignment agree not to balance bill you, but you should confirm this before the x-ray.

Some x-rays are more expensive than others. A straightforward chest x-ray costs less than a spine x-ray with multiple views. Your 20 percent share will be higher for the more complex x-ray, but the total amount Medicare approves is also lower for simpler images.

Medicare Advantage plan coverage for x-rays

Medicare Advantage plans must cover all the same x-rays that Original Medicare covers, but they can charge you differently. Your plan might charge a $30 copay for any x-ray, or it might charge coinsurance (for example, 20 percent of the cost). Some plans cover x-rays with no copay or coinsurance at all. A few plans require you to go to a specific imaging center in their network, while others let you go to any Medicare-approved facility.

Your plan's coverage details are in the Summary of Benefits and Coverage document that came with your plan materials, or you can find them on your plan's website. If you cannot find the information or are unsure, call the customer service number on your Medicare Advantage card. Ask specifically: "What will I pay for an x-ray at my doctor's office?" and "What will I pay for an x-ray at an urgent care center?" The answers may be different.

Some Medicare Advantage plans also have an out-of-pocket maximum — a yearly limit on what you pay for covered services. Once you reach that limit, the plan pays 100 percent of covered services for the rest of the year. If your plan has this feature, x-rays count toward that limit.

X-rays ordered in a hospital or emergency room

When you get an x-ray as part of a hospital inpatient stay (you are admitted to the hospital overnight), it is covered under Medicare Part A, not Part B. You pay a deductible for the hospital stay, and the x-ray is included in that cost — you do not pay separately for the x-ray itself.

If you go to a hospital emergency room and are not admitted to the hospital, the x-ray may be covered under Part B (you pay 20 percent after your deductible) or under Part A (you pay the hospital outpatient copay, which varies by service). The hospital bills it one way or the other, and you will see which on your bill. If you are unsure whether you were admitted or treated as an outpatient, call the hospital's billing department — this affects what you owe.

X-rays done at an outpatient hospital imaging center (you go in for the x-ray and leave the same day, not through the emergency room) are usually billed under Part B, so you pay 20 percent after your deductible. However, some hospitals bill outpatient imaging under Part A with a copay instead. Ask the hospital before your appointment which way they will bill it.

What to ask your doctor before getting an x-ray

Before your x-ray is scheduled, ask your doctor or the scheduling staff: "Is this x-ray covered by Medicare?" Most routine x-rays ordered for a medical reason are covered, but some are not. For example, x-rays for cosmetic reasons or x-rays that are considered experimental are not covered.

Ask where the x-ray will be done — at the doctor's office, an imaging center, or a hospital. This affects what you pay. If you have a Medicare Advantage plan, ask whether the facility is in your plan's network. If it is not, you may pay more or the plan may not cover it at all.

If you have Original Medicare, ask the facility whether they accept Medicare assignment. This means they agree to accept Medicare's approved amount as full payment and will not bill you for the difference. Most facilities do, but confirming ahead of time protects you.

When to contact Medicare or your plan about x-ray coverage

If your doctor orders an x-ray and you are not sure whether it is covered, call Medicare at 1-800-MEDICARE (1-800-633-4227) before the x-ray is done. Have your Medicare card ready. You can also visit Medicare.gov and use the search box to look up whether a specific type of x-ray is covered.

If you have a Medicare Advantage plan, call the customer service number on your plan card instead of calling Medicare. Your plan's rules may be different from Original Medicare's rules, and the plan can tell you exactly what you will pay.

If you receive a bill after your x-ray that seems wrong, do not ignore it. Call the facility's billing department and ask them to explain the charge. If you still disagree, you can file a complaint with Medicare. Original Medicare beneficiaries can call 1-800-MEDICARE. Medicare Advantage members should contact their plan first, then Medicare if the plan does not resolve it.

Frequently Asked Questions

Do I have to pay anything if I get an x-ray with Original Medicare?

Yes. You pay your Part B deductible (if you have not met it yet that year), then you pay 20 percent of the Medicare-approved amount. If the facility charges more than Medicare approves, you may owe that difference too. Some x-rays cost more than others, so your 20 percent share varies.

What if my Medicare Advantage plan says x-rays are not covered?

This is rare, because Medicare Advantage plans must cover the same x-rays that Original Medicare covers. If your plan's materials say an x-ray is not covered, call the plan's customer service to confirm. There may be a specific reason (like it is experimental or not medically necessary), and the plan can explain it.

Can I go to any imaging center for an x-ray, or do I have to use a specific one?

With Original Medicare, you can go to any Medicare-approved facility. With a Medicare Advantage plan, check your plan documents — some plans require you to use in-network facilities, while others let you go anywhere. Using an out-of-network facility may cost you more or may not be covered at all.

Will Medicare cover an x-ray if my doctor thinks I might have a broken bone?

Yes. X-rays ordered to diagnose or rule out a broken bone are covered. Your doctor must order it for a medical reason, and you will pay your usual share (20 percent under Original Medicare, or your plan's copay or coinsurance under Medicare Advantage).

What happens if I get an x-ray and then find out it was not covered?

Contact the facility's billing department and ask why it was not covered. If Medicare or your plan denied it, ask for the reason in writing. You have the right to appeal a denial. Call Medicare (1-800-MEDICARE for Original Medicare, or your plan's customer service for Medicare Advantage) to understand your options.