Yes, Medicare covers mammograms for women 70 and older at no cost
Medicare Part B covers screening mammograms once every 12 months for women age 40 and older, with no copay, coinsurance, or deductible. This coverage does not stop at 70. If you are 70 or older and enrolled in Original Medicare (Part A and Part B), you can continue to get a screening mammogram covered in full, as long as your doctor orders it or you request one at a participating facility.
The key word is screening — a mammogram to look for cancer in someone without symptoms. If you have symptoms like breast pain, a lump, or discharge, that becomes a diagnostic mammogram, which Medicare also covers but may have different cost-sharing rules depending on what your doctor finds and how the facility bills it.
Many women over 70 stop getting mammograms because they think coverage ends or because they assume screening is less important at an older age. Neither is true. Whether you should continue screening is a conversation to have with your doctor, but the cost is not the barrier — Medicare pays for it.
Key Takeaways
- Medicare Part B covers one screening mammogram per year for women 70 and older at no out-of-pocket cost.
- You must go to a Medicare-participating facility or have a doctor's order for the mammogram to be covered.
- Diagnostic mammograms (ordered because of symptoms) are also covered, though the cost-sharing may differ.
- If you have a Medicare Advantage plan instead of Original Medicare, check your plan's coverage, as rules vary by plan.
- Your doctor can help you decide whether annual screening is right for you based on your health and personal risk factors.
How to find a Medicare-participating mammography facility
Not every imaging center or hospital accepts Medicare, so you need to confirm before you schedule. The easiest way is to call your doctor's office and ask them to order the mammogram at a facility they know accepts Medicare. Your doctor's staff can often schedule it for you and will know which places are in your network if you have a Medicare Advantage plan.
You can also search the Medicare provider directory online at Medicare.gov. Go to the "Care Providers" section, select your state, and search for "mammography" or "breast imaging." The results will show you facilities near you and confirm they are Medicare-participating. Call ahead to confirm they accept your specific Medicare plan and to ask about wait times.
If you use a Medicare Advantage plan (Part C), your plan may have a narrower list of in-network providers. Check your plan's provider directory or call the member services number on your insurance card before scheduling.
Screening versus diagnostic mammograms and what each costs
A screening mammogram is ordered when you have no symptoms — it is a routine check. Medicare covers this at 100 percent with no copay. You can get one every 12 months.
A diagnostic mammogram is ordered because you or your doctor noticed something — a lump, pain, discharge, or an abnormal finding on a screening mammogram. Medicare covers diagnostic mammograms, but the cost to you depends on how the facility bills it. If the radiologist finds nothing wrong, it is usually covered at 100 percent. If they find something that needs follow-up, you may owe a copay or coinsurance depending on what happens next and whether you have met your deductible for the year.
The difference matters because some women delay getting symptoms checked because they worry about cost. Do not. Tell your doctor about any breast changes, and let Medicare's coverage handle the bill.
What to do if you have a Medicare Advantage plan
If you chose a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for mammograms is the same in principle — plans must cover at least what Original Medicare covers — but the details vary by plan. Some plans cover mammograms at no cost; others charge a copay. Some plans limit you to certain facilities or require a referral from your primary care doctor.
Check your plan's summary of benefits document or call the member services number on your insurance card and ask: "Does my plan cover screening mammograms, and is there a copay?" Also ask whether you need a referral from your primary care doctor and which facilities are in-network near you.
If your plan's coverage is less generous than Original Medicare or if you are unhappy with your plan for other reasons, you can switch to Original Medicare during the annual enrollment period (October 15 to December 7 each year) or during a special enrollment period if you have a may have access to life event.
When to talk to your doctor about screening after 70
Medicare pays for screening mammograms at any age, but whether you should get one every year is a personal decision between you and your doctor. Medical organizations have different recommendations. Some suggest continuing annual screening as long as you are in good health; others suggest screening every other year or stopping at a certain age.
Your doctor knows your health history, your family history of breast cancer, and your personal preferences. Bring up mammography at your next visit and ask: "Based on my health, should I continue getting a screening mammogram every year?" Your answer might be yes, no, or "let's do it every other year instead." The point is to make the choice together, not to avoid it because of cost.
If you have had breast cancer before, your doctor will have a specific screening plan for you, and Medicare will cover the mammograms that plan calls for.
What happens if you do not have Medicare Part B
Mammogram coverage requires Medicare Part B. If you enrolled in Medicare Part A only (hospital insurance) and did not sign up for Part B (medical insurance), you will not have coverage for mammograms. Part B is optional, but most people enroll when they turn 65 because it covers doctor visits, outpatient care, and preventive services like mammograms.
If you turned down Part B when you first became may be able to access and now want it, you can enroll during the general enrollment period (January 1 to March 31 each year), though you may owe a higher premium for each year you delayed. If you have a good reason for the delay — such as employer coverage that ended — you may be able to enroll without a penalty. Contact Social Security or Medicare to discuss your situation.
Frequently Asked Questions
Do I need a doctor's order to get a mammogram covered?
No, but it helps. You can walk into a Medicare-participating facility and request a screening mammogram, and Medicare will cover it. However, having your doctor order it ensures the facility knows it is a screening mammogram (not diagnostic) and may make scheduling easier. Ask your doctor's office to place the order.
What if my mammogram shows something abnormal?
If the screening mammogram finds something that needs more imaging or a biopsy, those follow-up tests are also covered by Medicare. You may owe a copay or coinsurance depending on what the tests are and whether you have met your Part B deductible. Ask the facility about costs before the follow-up procedure if you are concerned.
Can I get a mammogram at a hospital instead of an imaging center?
Yes, as long as the hospital's mammography department is Medicare-participating. Hospital-based mammography is covered the same way as imaging centers. Call the hospital's radiology department to confirm they accept Medicare and to schedule.
What if I want a 3D mammogram instead of a standard mammogram?
3D mammography (tomosynthesis) is covered by Medicare as a screening tool, though coverage rules have evolved. Ask your doctor or the facility whether they offer 3D mammography and whether it is covered under your specific Medicare plan. Some Medicare Advantage plans may have different rules.
Do I have to get a mammogram every year, or can I skip a year?
You do not have to get a mammogram every year. Medicare covers one per year, but whether you should get one is between you and your doctor. If your doctor recommends skipping a year or screening every other year, that is a valid choice. The coverage is there if you need it.