Medicare Covers Mammograms With No Cost to You

Medicare Part B covers mammograms at no cost — you pay nothing out of pocket, and there is no deductible. The coverage includes both screening mammograms (routine checks when you have no symptoms) and diagnostic mammograms (when a doctor suspects a problem). You must go to a facility that accepts Medicare, and your doctor must order the test or you must meet Medicare's age and risk requirements for screening.

The catch is that coverage rules differ slightly between screening and diagnostic mammograms, and not every imaging center handles both the same way. Understanding which type you need and where to go will prevent delays and bill surprises.

Key Takeaways

  • Medicare Part B covers screening mammograms once every 12 months for women 40 and older, with no cost to you.
  • Diagnostic mammograms (ordered because of symptoms or an abnormal result) are also covered at no cost when your doctor orders them.
  • You must use a Medicare-enrolled facility; calling ahead to confirm they accept Medicare prevents unexpected bills.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may differ, so check your plan documents first.

Screening Mammograms: What Medicare Covers

A screening mammogram is a routine X-ray of the breast when you have no symptoms. Medicare Part B covers one screening mammogram every 12 months for women age 40 and older. You do not pay the facility fee, the radiologist fee, or any other charge — Medicare pays the full amount.

You do not need a referral from your primary care doctor, but many women get one anyway because their doctor can order it directly and send it to a specific facility. You can also call an imaging center that accepts Medicare and request a screening mammogram on your own. Either way, the facility will verify your Medicare coverage before the appointment.

The 12-month window resets each time you have a screening. If you had one in March, your next covered screening is not until March of the following year. Some facilities track this automatically; others do not, so if you are unsure when your last one was, ask the facility to check your records.

Diagnostic Mammograms: When Your Doctor Orders One

A diagnostic mammogram is ordered when you have symptoms (pain, a lump, discharge) or when a screening mammogram showed something that needs closer look. Medicare Part B covers diagnostic mammograms at no cost, with no limit on how many you can have in a year. Your doctor must order it, and the radiologist will perform additional views or imaging to investigate the finding.

Diagnostic mammograms often take longer than screening mammograms because the radiologist is looking at a specific area. You will typically get results the same day or within a few days. If the radiologist finds something that needs follow-up, Medicare will also cover any additional imaging or biopsies your doctor orders.

How to Find a Medicare-Enrolled Mammography Facility

Not every imaging center or hospital is enrolled in Medicare, and some enroll only for certain services. Before you schedule, confirm the facility accepts Medicare. The easiest way is to call the facility directly and ask: "Do you accept Medicare for mammograms?" If they say yes, ask them to verify your coverage before your appointment so there are no surprises.

You can also search Medicare's provider directory online at Medicare.gov. Enter your zip code and search for "mammography" to see which facilities near you are enrolled. The directory shows whether they accept new patients and their address and phone number. If you use this method, still call the facility to confirm they have current availability and to schedule.

If you live in a rural area or have trouble finding a nearby facility, ask your doctor for a referral. Doctors often know which facilities accept Medicare and can sometimes arrange transportation or connect you with community resources.

What Happens If You Go to a Non-Medicare Facility

If you have a mammogram at a facility that does not accept Medicare, Medicare will not pay, and you will receive a bill. The facility may bill you the full amount, or Medicare may send you a notice saying they cannot pay and you are responsible. Either way, you will owe money.

If this happens, you can ask the facility to bill Medicare anyway and request a refund if Medicare denies it. You can also file an appeal if you believe the facility should have been enrolled or if you were not told in advance that they do not accept Medicare. Keep all paperwork — the bill, the appointment confirmation, and any notices from Medicare — because you will need them for an appeal.

Medicare Advantage and Medigap: Different Rules

If you have a Medicare Advantage plan (Part C), your mammogram coverage may differ. Most Medicare Advantage plans cover screening and diagnostic mammograms at no cost, but some require you to use in-network facilities or may have different frequency limits. Check your plan's summary of coverage or call the plan directly before scheduling.

If you have a Medigap plan (supplemental insurance), it typically covers the cost-sharing that original Medicare does not pay. Since original Medicare covers mammograms at no cost, Medigap does not add anything. However, if you go out of network or to a non-enrolled facility, Medigap will not cover the bill either.

What to Bring and Expect on the Day

Bring your Medicare card and a photo ID. The facility will ask for your insurance information and may ask you to sign a form confirming you understand Medicare will pay. If you have a referral from your doctor, bring that too, though it is not always required for screening mammograms.

Wear a two-piece outfit so you can undress only the top. The appointment usually takes 15 to 30 minutes. You will change into a gown, and the technician will position your breast on the mammography machine and take images from different angles. It can be uncomfortable but is not painful for most people. You will not receive results on the spot; the radiologist reviews the images and sends a report to your doctor, usually within a few days.

Frequently Asked Questions

Do I need a doctor's order for a screening mammogram?

No. Medicare covers screening mammograms for women 40 and older without a referral. You can call a Medicare-enrolled facility and schedule one yourself. Many women ask their doctor to order one anyway because it ensures the facility has the order in advance and can route results back to the doctor.

What if I am under 40 and want a mammogram?

Medicare does not cover screening mammograms for women under 40. If your doctor believes you need one because of symptoms or family history, ask whether it would be considered diagnostic rather than screening. If your doctor orders it for a medical reason, Medicare may cover it. Otherwise, you will pay out of pocket or check whether your state Medicaid program covers it.

How often can I have a mammogram covered by Medicare?

One screening mammogram every 12 months is covered. Diagnostic mammograms have no frequency limit — if your doctor orders them, Medicare covers them. If you have had multiple diagnostic mammograms in one year, that is normal and covered.

Will I get a bill if I go to a Medicare facility?

No. If the facility is enrolled in Medicare and you bring your Medicare card, you should not receive a bill. If you do, contact Medicare or the facility to ask why. It may be a billing error, or the facility may have submitted the claim incorrectly.

What if the mammogram shows something abnormal?

Your doctor will contact you with results and next steps. Any follow-up imaging, ultrasound, or biopsy your doctor orders is also covered by Medicare at no cost. Do not delay calling your doctor if you do not hear results within a week.