Medicare covers yearly mammograms after age 75, but only if your doctor orders them
Medicare Part B covers one screening mammogram per year for women age 40 and older, with no copay. This coverage continues after age 75. However, Medicare will only pay for the mammogram if a doctor has ordered it — you cannot schedule one on your own and expect Medicare to cover it. The order must come from your primary care doctor, gynecologist, or another physician who is treating you.
The mammogram must be done at a facility that is certified by the FDA. If you go to an uncertified facility, Medicare will not cover the cost, even with a doctor's order. Most hospitals and imaging centers are certified, but it is worth confirming before your appointment.
If your doctor finds something suspicious on a screening mammogram, any follow-up imaging — such as a diagnostic mammogram or ultrasound — is covered separately. You may have a copay for these follow-up visits, depending on your specific plan.
Key Takeaways
- Medicare Part B covers one screening mammogram per year for women age 75 and older at no cost, but only with a doctor's order.
- The facility performing the mammogram must be FDA-certified, or Medicare will not cover the cost.
- If your doctor recommends more frequent mammograms due to personal risk factors, you may have to pay out of pocket unless your plan covers additional screenings.
- Diagnostic mammograms ordered after an abnormal screening are covered separately and may have a copay.
- Your doctor decides whether yearly screening is right for you based on your health history and risk factors.
How to get a covered mammogram after 75
Call your primary care doctor or gynecologist and ask for a screening mammogram order. Tell them you want the order sent to a specific facility if you have a preference. Your doctor will review your health history and decide whether a yearly mammogram is appropriate for you.
Once you have the order, call an FDA-certified imaging center or hospital and schedule your appointment. When you call, tell them you have Medicare and ask them to confirm they are certified. Bring your Medicare card and any other insurance cards you carry. You will not owe anything at the time of service if the facility is certified and the order is from your doctor.
If you do not have a primary care doctor, you can see a gynecologist directly for a mammogram order. Many women over 75 see their gynecologist annually for this reason.
When doctors recommend stopping mammograms after 75
Some doctors recommend that women over 75 stop routine screening mammograms, especially if they have other serious health conditions or a limited life expectancy. This is a medical decision, not a Medicare rule. Medicare will cover the mammogram if your doctor orders it, regardless of your age.
The American Cancer Society and U.S. Preventive Services Task Force both say that the decision to screen after 75 should be made between you and your doctor based on your individual health, family history, and preferences. If you have had normal mammograms for many years and no family history of breast cancer, your doctor might suggest stopping. If you have a personal history of breast cancer or strong family risk, your doctor will likely recommend continuing.
If your doctor suggests stopping but you want to continue, you can ask for a second opinion or request the mammogram anyway. Medicare will still cover it if your doctor orders it.
What happens if you need a diagnostic mammogram
If your screening mammogram shows something that needs further investigation, your doctor will order a diagnostic mammogram or other imaging. These follow-up tests are covered by Medicare separately from the screening mammogram. You may have a copay depending on whether you have Original Medicare or a Medicare Advantage plan.
Diagnostic mammograms often take longer than screening mammograms because the technician focuses on a specific area. You may also have an ultrasound or MRI ordered. All of these are covered by Medicare if your doctor orders them in response to an abnormal screening result.
If you have a Medicare Advantage plan instead of Original Medicare
Medicare Advantage plans (Part C) must cover at least the same mammogram benefits as Original Medicare — one screening mammogram per year with no copay. However, some plans cover additional screenings or waive copays for diagnostic imaging. Check your plan documents or call your plan's customer service line to see what your specific coverage is.
Some Medicare Advantage plans partner with specific imaging centers or require you to use in-network facilities. If you have a preference for where you get your mammogram, call your plan first to confirm the facility is in-network and that your coverage applies there.
Cost if you do not have Medicare or if the mammogram is not covered
If you do not have Medicare or if your mammogram is not covered for any reason, the cost varies widely by location and facility. A screening mammogram at a hospital can cost between $100 and $300 out of pocket. Some community health centers and breast cancer organizations offer low-cost or free mammograms to uninsured women, particularly those with limited income.
If you are uninsured or underinsured, call your local health department or a nearby teaching hospital to ask about screening programs in your area. The National Breast Cancer Foundation and American Cancer Society both maintain lists of facilities that offer reduced-cost mammograms.
What to ask your doctor before scheduling
Before your appointment, ask your doctor these questions:
- Do you recommend I continue yearly screening mammograms at my age?
- Are there any risk factors in my health history that would change how often I should be screened?
- Will you send the order to a specific facility, or should I choose one?
- If the mammogram shows something abnormal, what happens next and what will that cost me?
- How long does it usually take to get results, and how will you contact me?
When to contact your doctor about mammogram results
Most mammogram results come back within one to two weeks. Your doctor's office should contact you with the results. If you do not hear back within three weeks, call your doctor's office to ask about your results.
If your results show something abnormal, your doctor will contact you to discuss next steps. Do not wait for a letter in the mail — call your doctor's office if you have not heard anything after two weeks.
If you have symptoms such as a lump, pain, or discharge from your breast, contact your doctor right away rather than waiting for a scheduled mammogram. These symptoms need to be evaluated promptly, and your doctor may order a diagnostic mammogram or ultrasound sooner.
Frequently Asked Questions
Do I need a doctor's order every year, or can I use the same order multiple times?
You need a new order each year. Your doctor should issue a fresh order annually when you ask for a mammogram. Some doctors' offices will call you when it is time for your yearly screening, but many expect you to call and request it.
What if my doctor says I should not have a mammogram but I want one anyway?
You can request the mammogram in writing and ask your doctor to document your request in your medical record. If your doctor still refuses to order it, you can see another doctor for a second opinion. Medicare will cover the mammogram if any doctor orders it.
Will Medicare cover a 3D mammogram instead of a regular mammogram?
Yes, Medicare covers 3D mammography (tomosynthesis) as a screening test. It is covered the same way as a standard mammogram — one per year with no copay if ordered by your doctor at a certified facility.
What if I am over 75 and have never had a mammogram before?
Medicare will cover your first screening mammogram if your doctor orders it. Your doctor will discuss whether screening is right for you at this stage of life based on your health and risk factors. Starting screening for the first time after 75 is less common but is a decision you and your doctor can make together.
Can I get a mammogram at a different facility than my doctor recommends?
Yes. Your doctor will issue the order, and you can take it to any FDA-certified facility. If you have a Medicare Advantage plan, confirm the facility is in-network first. You can also ask your doctor to send the order directly to the facility of your choice.