Medicare covers one screening mammogram per year at no cost to you

Medicare Part B pays for a screening mammogram once every 12 months for women age 40 and older. You pay nothing — no copay, no coinsurance, no deductible — as long as you see a doctor or facility that accepts Medicare. This is true whether you have Original Medicare or a Medicare Advantage plan, though Advantage plans sometimes add their own coverage rules on top of Medicare's.

A screening mammogram is an X-ray of the breast to look for cancer in a woman without symptoms. It is different from a diagnostic mammogram, which Medicare covers differently and which a doctor orders when you have symptoms or an abnormal screening result.

Key Takeaways

  • Medicare Part B covers one screening mammogram every 12 months at no cost if you are age 40 or older.
  • Diagnostic mammograms (ordered because of symptoms or an abnormal result) are covered separately and may have a copay or coinsurance depending on your plan.
  • You must go to a Medicare-enrolled facility — ask before your appointment whether the facility accepts Medicare.
  • If you have a Medicare Advantage plan, check your plan documents or call the plan to confirm coverage, because some plans cover more frequently or with different rules.
  • The 12-month period resets each time you have a mammogram, not on a calendar year.

What happens if you need a mammogram more than once a year

If your doctor orders a second mammogram within 12 months because of a lump, pain, discharge, or an abnormal first result, that second mammogram is a diagnostic mammogram. Medicare covers diagnostic mammograms with the same copay or coinsurance as other outpatient services — usually 20% of the cost after you meet your deductible, though the exact amount depends on where you have it done.

Your doctor decides whether a second mammogram is medically necessary. You do not need to ask Medicare for permission first. If the facility questions coverage, have your doctor's office send a note explaining why the second mammogram was ordered.

How the 12-month period works

The 12 months runs from the date of your last mammogram, not from January 1. If you had a screening mammogram on March 15, you can have another covered screening mammogram on March 15 of the next year or any time after. If you try to schedule one before 12 months have passed and the facility bills it as a screening mammogram, you may be charged.

If you are unsure when your last mammogram was, call your doctor's office or the facility where you had it done. They can tell you the exact date and whether you are may be able to access for a free screening now.

Medicare Advantage plans and mammogram coverage

Medicare Advantage plans (Part C) must cover at least what Original Medicare covers — one screening mammogram per year at no cost. However, some Advantage plans cover more: they may pay for screening mammograms twice a year, or they may waive the copay on diagnostic mammograms. A few plans also cover supplemental screening like ultrasound or MRI for women with dense breast tissue, though this varies widely.

Check your plan's summary of benefits or call the plan's member services line before your appointment. The plan can tell you exactly what you will pay and whether the facility you want to use is in network. If the facility is out of network, you may owe more.

What you need to bring and questions to ask beforehand

Bring your Medicare card and any insurance card you have (Advantage plan card, if you have one). Call the mammography facility at least a few days before your appointment and confirm three things: that they accept Medicare, that they are in network if you have an Advantage plan, and whether they need any paperwork from your doctor ahead of time.

Ask the facility directly what you will pay. If they say you owe a copay for a screening mammogram, ask them to verify with Medicare that you have not had one in the past 12 months. Facilities sometimes bill incorrectly, and catching it before your appointment is easier than disputing a bill afterward.

Supplemental screening and coverage gaps

If your doctor recommends supplemental screening — such as breast ultrasound or MRI — because you have dense breast tissue or high risk, Medicare may not cover it. Coverage depends on your specific situation and the reason your doctor ordered it. Some Advantage plans cover supplemental screening; Original Medicare does not always.

Ask your doctor whether the supplemental test is medically necessary for your situation, and ask the facility what it will cost if Medicare does not cover it. Some facilities offer financial information or payment plans. If cost is a barrier, tell your doctor — they may have other options or can help you understand the risk of skipping the test.

When to seek care and what to watch for

You do not need to wait for your annual mammogram if you notice a lump, dimpling, discharge, or skin changes in your breast. Call your doctor right away. Your doctor can order a diagnostic mammogram when ready, and Medicare will cover it regardless of when your last screening was.

If you have had breast cancer or have a family history of breast cancer, your doctor may recommend screening more often than once a year. Medicare will cover those additional mammograms as diagnostic studies if your doctor documents the medical reason.

Frequently Asked Questions

Do I have to go to a specific facility for Medicare to cover my mammogram?

No, but the facility must be enrolled in Medicare. Most hospitals and imaging centers are. Call ahead to confirm, or ask your doctor's office which facilities near you accept Medicare. If you go to a non-enrolled facility, you will likely owe the full cost.

What if I had a mammogram at a private clinic that I paid for out of pocket — does that reset my 12-month clock?

No. Medicare only counts mammograms that were billed to Medicare or that you reported to Medicare. If you paid privately, Medicare's 12-month period is based on your last Medicare-covered mammogram. Tell your doctor's office about any private mammograms so they have your complete history.

Can I get a mammogram at age 39 if I am worried about breast cancer?

Medicare does not cover screening mammograms for women under 40. If you are under 40 and have symptoms or high risk, talk to your doctor about whether a mammogram is appropriate and what it will cost. Some private insurance or community health centers may cover it, but Medicare will not.

If I have both Original Medicare and a Medigap plan, who pays for my mammogram?

Original Medicare pays first and covers the full cost of a screening mammogram. Your Medigap plan does not need to pay anything. If you had a diagnostic mammogram with a copay, your Medigap plan might cover that copay depending on your plan type, but you would need to check your plan documents.

What should I do if a facility bills me for a screening mammogram that should have been free?

Contact the facility's billing department and explain that Medicare should have covered it at no cost. Ask them to resubmit the claim to Medicare. If they do not fix it, contact Medicare at 1-800-MEDICARE to report the billing error. Keep copies of all bills and correspondence.