Medicare covers one screening mammogram per year at no cost to you

Medicare Part B covers a screening mammogram once every 12 months for women age 40 and older. You pay nothing for the mammogram itself — no copay, no coinsurance, no deductible — as long as you go to a provider that accepts Medicare and the facility is certified by the FDA.

A screening mammogram is an X-ray of the breast used to look for signs of cancer in women without symptoms. This is different from a diagnostic mammogram, which is done when you have symptoms or when a screening found something that needs closer look. Medicare covers diagnostic mammograms under different rules, and you may have a copay or coinsurance for those.

Key Takeaways

  • Medicare Part B covers one screening mammogram every 12 months for women 40 and older at no cost to you.
  • The facility must be FDA-certified and the provider must accept Medicare, or you may owe the full cost.
  • Diagnostic mammograms (done because of symptoms or abnormal findings) are covered but may have a copay or coinsurance.
  • You do not need a referral from your doctor, but telling your doctor you are having one is still a good idea.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may differ, so check your plan documents.

How to make sure your mammogram is covered

Before you schedule, confirm that the imaging center or hospital is Medicare-certified. You can search for certified facilities on the FDA's National Mammography Database at fda.gov, or call the facility directly and ask whether they accept Medicare and hold FDA certification.

Tell the staff that you want a screening mammogram (not diagnostic) and that you are using Medicare. If the facility is certified and accepts Medicare, you should owe nothing. If they tell you there will be a charge, ask why — it may be that they do not accept Medicare, or that they are billing it as diagnostic rather than screening.

If you have a Medigap policy (supplemental insurance), it will typically cover your Part B coinsurance and copays, which means you still pay nothing. If you have a Medicare Advantage plan, your out-of-pocket cost depends on your plan — some cover screening mammograms with no cost, others charge a copay. Check your plan's summary of benefits or call the plan directly before you schedule.

Screening versus diagnostic mammograms

A screening mammogram is done when you have no symptoms and no known breast problem. Medicare covers one per year at no cost. This is the routine mammogram most women get as part of regular health care.

A diagnostic mammogram is done when you have symptoms (like a lump or pain), when a screening mammogram found something unusual, or when your doctor orders one for another reason. Medicare covers diagnostic mammograms, but you may owe a copay or coinsurance because they are considered a medical service rather than preventive care. The amount varies depending on your plan and whether you have met your deductible.

If your screening mammogram shows something that needs more imaging, the follow-up diagnostic mammogram is usually covered as a separate service. Ask the facility what your cost will be before the procedure.

What happens if you need more than one mammogram per year

Medicare covers only one screening mammogram every 12 months. If you need a second mammogram within that year — for example, because the first one showed something unclear — that second mammogram is usually billed as diagnostic, not screening. You may owe a copay or coinsurance for it.

Some women with a personal or family history of breast cancer may benefit from more frequent screening or additional imaging like ultrasound or MRI. Talk to your doctor about whether you need more than annual screening. If your doctor orders additional imaging, Medicare will cover it as medically necessary, though you may have out-of-pocket costs depending on your plan.

Medicare Advantage and Medigap differences

If you are enrolled in Original Medicare (Part A and Part B), screening mammograms are free. Diagnostic mammograms have a copay or coinsurance.

If you have a Medicare Advantage plan (Part C), your coverage and costs depend on your specific plan. Some plans cover screening mammograms with no cost, while others charge a copay. Call your plan or check your member handbook to find out what you owe.

If you have a Medigap policy, it covers your Part B copays and coinsurance, so you typically pay nothing for either screening or diagnostic mammograms. Medigap does not cover Medicare Advantage plans — you have one or the other, not both.

Age and coverage rules

Medicare covers screening mammograms for women age 40 and older. There is no upper age limit — if you are 75, 85, or older and have Medicare Part B, you can still get a covered screening mammogram once per year.

Some women under 40 may have Medicare if they receive disability benefits or have end-stage renal disease. Coverage rules for screening mammograms are the same for them as for older women, though your doctor may recommend different screening intervals based on your individual risk.

Frequently Asked Questions

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

No, you do not need a referral. You can call a Medicare-certified imaging center or your doctor's office and schedule one yourself. That said, telling your doctor you are having a mammogram is still a good idea so the results can be added to your medical record.

What if my mammogram shows something and I need a biopsy?

A biopsy is a diagnostic procedure, not a screening service. Medicare covers it, but you may owe a copay or coinsurance depending on where it is done and whether you have met your deductible. Ask the facility for an estimate before the procedure.

Can I get a mammogram at a different facility than my regular doctor?

Yes. As long as the facility is Medicare-certified and accepts Medicare, your screening mammogram is covered. You do not have to use your doctor's office or a hospital — a standalone imaging center that is certified will work.

What if I had a mammogram at a non-certified facility and got a bill?

Contact the facility and ask why you were charged. If they are not Medicare-certified, they should not have billed Medicare. You can also contact Medicare at 1-800-MEDICARE to report the issue and ask for help.

Does Medicare cover 3D mammograms?

Yes. 3D mammography (tomosynthesis) is covered as a screening mammogram if the facility is certified to perform it and your doctor orders it. You pay nothing if it is billed as screening. Some plans may cover it differently, so check with your Medicare Advantage plan if you have one.