Medicare covers mammograms at no cost to you as part of preventive care

Yes. Medicare Part B covers screening mammograms — the X-rays used to check for breast cancer in people without symptoms — at no charge. You pay nothing: no copay, no coinsurance, no deductible. This coverage applies once every 12 months for women 40 and older, and once every 24 months for women 50 and older, depending on your age and risk factors.

The coverage includes the mammogram itself and the radiologist's reading of the images. If your doctor orders the mammogram as a screening test (looking for cancer when you have no symptoms), Medicare pays the full cost. If the mammogram finds something that needs follow-up — like an ultrasound or biopsy — those additional tests may have different cost-sharing rules, which we explain below.

You must go to a facility that is Medicare-approved for this coverage to explore. Most hospitals, imaging centers, and breast cancer screening programs are approved, but it is worth confirming before your appointment.

Key Takeaways

  • Medicare Part B covers one screening mammogram every 12 months for women 40 and older at no cost to you.
  • You must receive the mammogram at a Medicare-approved facility for the coverage to explore.
  • If the mammogram finds something abnormal, follow-up tests like ultrasounds or biopsies are covered under different rules and may involve cost-sharing.
  • Diagnostic mammograms (ordered because of symptoms or abnormal findings) are also covered, but you may owe a copay or coinsurance depending on your plan.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may differ from Original Medicare.

The difference between screening and diagnostic mammograms

Medicare distinguishes between two types of mammograms, and the coverage rules differ. A screening mammogram is done when you have no symptoms and no known breast problems — it is a routine check. Medicare covers this at no cost once per year (or once every two years, depending on your age and risk). You pay nothing.

A diagnostic mammogram is ordered when you have a symptom (like a lump or pain), an abnormal finding from a previous mammogram, or a family history of breast cancer that your doctor wants to investigate. For a diagnostic mammogram, you typically pay a copay or coinsurance — usually 20% of the cost after you meet your Part B deductible. The exact amount depends on whether you have Original Medicare or a Medicare Advantage plan.

The key is what your doctor writes on the order. If it says "screening," Medicare treats it as preventive and covers it fully. If it says "diagnostic," cost-sharing applies. If you are unsure which type you are receiving, ask your doctor or the imaging center before your appointment.

What happens if the mammogram finds something abnormal

If your screening mammogram shows an area that needs closer look, your doctor will order additional imaging or a biopsy. These follow-up tests are usually covered, but the cost-sharing rules change. An ultrasound or MRI ordered to investigate an abnormal mammogram is typically treated as a diagnostic service, so you may owe a copay or 20% coinsurance after your deductible.

A breast biopsy — a procedure to remove tissue for testing — is also covered by Medicare Part B. If it is done in a hospital outpatient setting, you pay a copay (usually $250 to $500, depending on the facility). If it is done in an office or imaging center, you typically pay 20% coinsurance after your deductible.

The total cost for follow-up care can add up, so it is worth understanding your plan before the appointment. If you have Original Medicare and want to limit your costs, you may want to review your Medigap coverage or ask the facility about their financial counseling services.

Coverage rules for different ages and risk levels

Medicare's screening mammogram coverage depends on your age. Women 40 to 49 can receive one screening mammogram every 12 months at no cost. Women 50 and older can receive one screening mammogram every 24 months at no cost. Some women with higher risk — such as those with a family history of breast cancer or a genetic mutation like BRCA1 or BRCA2 — may be covered for more frequent screening, but this requires your doctor to document the medical reason.

If your doctor believes you need screening more often than the standard frequency, they can request it, and Medicare will usually cover it if the medical reason is documented. However, you should confirm with your doctor and the imaging center that the additional screening will be covered before you go in.

These rules explore to Original Medicare (Parts A and B). If you have a Medicare Advantage plan, the coverage may be the same, but some plans offer additional preventive services or different cost-sharing. Check your plan's summary of coverage or call the plan directly to confirm.

How to find a Medicare-approved mammography facility

To receive your mammogram at no cost, you must use a facility that is certified by Medicare. You can search for approved facilities on the Centers for Medicare & Medicaid Services (CMS) website using their facility locator tool, or you can call your doctor's office — they usually know which imaging centers accept Medicare and are approved.

Most large hospitals, breast imaging centers, and community health centers are Medicare-approved. Smaller or newer facilities may not be, so it is worth a quick phone call to confirm before you schedule. When you call to book your appointment, straightforward ask: "Is your facility Medicare-approved for screening mammograms?" If the answer is yes, your coverage should explore.

You can also ask your primary care doctor for a referral to a Medicare-approved facility in your area. Many doctors have preferred imaging partners they work with regularly.

What to bring to your mammogram appointment

Bring your Medicare card and any other insurance cards you have (such as a Medigap or Medicare Advantage card). Bring a photo ID. If your doctor gave you a written order for the mammogram, bring that too — it helps the facility confirm the type of mammogram and may support the correct billing code is used.

If you have had previous mammograms at a different facility, let the imaging center know. They may request your prior images for comparison, which can improve the accuracy of the screening.

Wear comfortable, loose-fitting clothing that is straightforward to remove from the waist up. Avoid wearing deodorant, antiperspirant, powder, or lotion on the day of your appointment — these can show up on the images and may require additional pictures.

Medicare Advantage and Medigap coverage for mammograms

If you are enrolled in a Medicare Advantage plan (Part C), your coverage for screening mammograms is the same as Original Medicare — at no cost. However, some Medicare Advantage plans offer additional preventive services, such as supplemental breast cancer screening or 3D mammography (tomosynthesis), which may be covered at a lower cost than they would be under Original Medicare. Check your plan's summary of coverage to see what is included.

If you have a Medigap plan (supplemental insurance), it typically covers the copay or coinsurance you would owe for a diagnostic mammogram under Original Medicare. For example, if you owe 20% coinsurance for a diagnostic mammogram, your Medigap plan usually pays that 20%. However, Medigap does not change the fact that screening mammograms are free — it only helps with costs you would otherwise owe.

If you are unsure what your specific plan covers, call the plan's member services number on your insurance card. They can tell you exactly what you will owe for a screening or diagnostic mammogram at a specific facility.

Frequently Asked Questions

Do I have to get a doctor's order for a free screening mammogram?

No. You can schedule a screening mammogram directly at a Medicare-approved facility without a doctor's order. However, having an order from your doctor can make the process smoother and ensures the facility bills it correctly as a screening test. If you are unsure, call your doctor's office and ask if they can send an order to the imaging center.

What if I am younger than 40 and want a mammogram?

Medicare does not cover screening mammograms for women under 40. If your doctor believes you need one due to symptoms or high risk, they can order a diagnostic mammogram, and Medicare will cover it, but you will owe cost-sharing (copay or coinsurance). Some private insurance plans or community health programs may cover screening for younger women — ask your doctor or local health department about other options.

Will I owe anything if my screening mammogram is abnormal?

The screening mammogram itself is free. However, if follow-up imaging or a biopsy is needed, those services are usually treated as diagnostic and may involve cost-sharing. Ask the facility about the likely cost of follow-up before you leave, so you are not surprised later.

Can I get a 3D mammogram (tomosynthesis) covered by Medicare?

3D mammography is covered by Medicare, but it is usually treated as a diagnostic service rather than a screening service, which means you may owe a copay or coinsurance. Some Medicare Advantage plans cover 3D mammography as part of routine screening at no cost — check your plan's coverage. If you have Original Medicare and want 3D imaging, ask your doctor whether the medical reason justifies it and whether your Medigap plan (if you have one) will cover the cost-sharing.

What if the imaging center says my mammogram is not covered?

Call Medicare directly at 1-800-MEDICARE (1-800-633-4227) or contact your plan's member services. Provide the facility name, the date of service, and the reason they gave for non-coverage. Medicare can often resolve billing disputes and may issue a refund if you were incorrectly charged for a covered service.