Medicare covers mammograms with no copay or coinsurance when you use an in-network provider
Medicare Part B covers screening mammograms — the routine kind used to check for breast cancer in people without symptoms — at no cost to you. You pay nothing out of pocket if you go to a provider that accepts Medicare. The coverage applies once every 12 months for women 40 and older, and once every two years for women 35 to 39 at high risk.
Diagnostic mammograms — ordered because you have symptoms or a previous abnormal result — are also covered with no copay. The difference matters because screening is preventive (covered fully), while diagnostic is treatment-related (also covered fully, but tracked separately in your claims).
The catch is that the provider must be in-network and must accept assignment, meaning they bill Medicare directly at the Medicare rate. If you go to an out-of-network facility, you may owe the full cost upfront and have to file for reimbursement yourself.
Key Takeaways
- Screening mammograms are free under Medicare Part B when performed at an in-network facility, with no copay or deductible.
- You must be 40 or older for annual screening coverage, or 35 to 39 if you are at high risk for breast cancer.
- Diagnostic mammograms ordered for symptoms or abnormal results are also fully covered with no cost-sharing.
- Always confirm the facility accepts Medicare assignment before your appointment to avoid unexpected bills.
- 3D mammograms (tomosynthesis) are covered the same way as standard mammograms under current Medicare policy.
How to find a Medicare-approved mammography provider
Use the Medicare provider search tool at Medicare.gov to locate in-network facilities near you. Search for "mammography" or "breast imaging" and filter by your location. The results show which providers accept Medicare assignment.
You can also call your Medicare Advantage plan directly if you are enrolled in one — they maintain their own networks and may have different in-network providers than Original Medicare. Your plan's member handbook lists covered facilities, or you can call the number on your insurance card.
Before you schedule, call the facility and confirm three things: that they accept Medicare, that they accept assignment (bill Medicare directly), and whether you need a referral from your primary care doctor. Some facilities require a doctor's order even though Medicare does not.
Screening versus diagnostic mammograms and what each covers
A screening mammogram is a routine X-ray of both breasts when you have no symptoms. Medicare covers one per year for women 40 and older, and one every two years for women 35 to 39 at high risk. You pay nothing. This is the standard preventive test.
A diagnostic mammogram is ordered when you have a symptom (lump, pain, discharge) or when a screening mammogram found something unusual. It takes longer, uses more images, and may include ultrasound or other imaging. Medicare covers this with no copay as well, even if you need it more than once a year.
The distinction matters for your records and for billing, but not for your out-of-pocket cost — both are free. If your doctor orders a diagnostic mammogram, make sure the facility codes it correctly so there is no confusion about coverage.
What happens if you need follow-up imaging after a mammogram
If your mammogram shows something that needs closer look, follow-up imaging — such as ultrasound, MRI, or additional mammogram views — is covered under Medicare Part B. You pay nothing for these tests when ordered by your doctor and performed at an in-network facility.
The facility will typically schedule follow-up imaging at the same visit or call you within a few days. Make sure the follow-up facility also accepts Medicare assignment. If you are referred to a different provider, ask whether they accept Medicare before you go.
Biopsies ordered after imaging are also covered. If a biopsy is needed, Medicare covers the procedure itself, the pathology reading, and any imaging guidance used during the biopsy. Again, no copay if the facility is in-network.
Medicare Advantage plans and mammogram coverage
If you are enrolled in a Medicare Advantage plan (Part C), your coverage for mammograms is the same — no copay for screening or diagnostic mammograms — but you must use in-network providers within your plan. Out-of-network facilities may not be covered at all, or may require you to pay the full cost.
Some Medicare Advantage plans cover additional screening beyond what Original Medicare requires, such as annual screening for women 35 to 39 at average risk, or supplemental imaging like 3D mammography. Check your plan's summary of coverage or call your plan to learn what is included.
If you switch between Original Medicare and a Medicare Advantage plan, or between plans, your coverage may change. Review your new plan's coverage documents before your next mammogram to avoid surprises.
Out-of-network facilities and what you might owe
If you go to a facility that does not accept Medicare or does not accept assignment, you may be billed for the full cost of the mammogram. This can range from $100 to $300 or more, depending on the facility and the type of mammogram.
Some out-of-network providers will bill Medicare on your behalf and you can request reimbursement, but you will have to pay upfront. Medicare will reimburse you based on the Medicare-approved amount, which is usually less than what the facility charges. You are responsible for the difference.
To avoid this, always confirm in-network status and assignment before scheduling. If you accidentally go out-of-network, ask the facility for an itemized bill and contact Medicare to file a claim for reimbursement.
Special situations: Supplemental insurance and cost-sharing
If you have a Medigap (supplemental insurance) policy, it covers the copays and coinsurance that Original Medicare does not pay. Since Medicare covers mammograms with no copay, Medigap does not add anything — you still pay nothing.
If you have both Original Medicare and Medicaid (dual may be able to access), Medicaid may cover services Medicare does not, but mammograms are already fully covered by Medicare, so Medicaid involvement is minimal. Always show both cards at the facility.
If you are under 65 and have Medicare due to disability or end-stage renal disease, the same mammogram coverage rules explore. You are covered for screening and diagnostic mammograms with no copay.
Frequently Asked Questions
Do I need a referral from my doctor to get a mammogram covered by Medicare?
Medicare does not require a referral, but many facilities do as a matter of policy. Call ahead and ask. If your doctor has not ordered one, you can request one at your annual wellness visit, or you can go directly to a facility that accepts walk-ins for screening mammograms.
Will Medicare cover a 3D mammogram instead of a standard 2D mammogram?
Yes. 3D mammography (tomosynthesis) is covered by Medicare with the same no-copay benefit as standard mammograms. Some facilities offer it as the default screening method. There is no extra charge to you, though the facility's cost to perform it is higher.
What if my mammogram shows something and I need a biopsy?
Biopsies ordered after a mammogram are fully covered by Medicare with no copay. The biopsy procedure, the pathology lab work, and any imaging used to guide the biopsy are all included. You pay nothing if the facility is in-network.
Can I get a mammogram every six months instead of once a year?
Medicare covers one screening mammogram per year for women 40 and older. If your doctor orders more frequent mammograms for a medical reason, they are coded as diagnostic rather than screening, and Medicare still covers them with no copay. Discuss with your doctor whether more frequent screening is medically necessary.
What if I am 35 to 39 and want a screening mammogram?
Medicare covers screening mammograms for women 35 to 39 only if you are at high risk for breast cancer. Your doctor must document the risk factors. If you are average risk, a screening mammogram at that age is not covered, but a diagnostic mammogram ordered for symptoms would be.