Medicare covers one screening mammogram per year at no cost to you
If you are a woman age 40 or older, Original Medicare (Part B) pays for one screening mammogram every 12 months with no deductible and no copay. A screening mammogram is an X-ray of the breast to look for cancer in a woman without symptoms. Medicare also covers a baseline mammogram for women between 35 and 39 — one time only — to establish a comparison for future images.
If your doctor finds something suspicious on a screening mammogram and orders a diagnostic mammogram to investigate further, Medicare covers that visit separately. Diagnostic mammograms are not subject to the once-per-year limit because they are medically necessary follow-up, not routine screening.
If you have Medicare Advantage (Part C), your plan must cover at least the same screening mammogram benefit as Original Medicare, but some plans may offer additional coverage — for example, more frequent screening or lower out-of-pocket costs. Check your plan documents or call the plan directly to learn what your specific coverage is.
Key Takeaways
- Original Medicare covers one screening mammogram per calendar year at no cost if you are 40 or older.
- A baseline mammogram between ages 35 and 39 is covered once to establish a comparison for future screening.
- Diagnostic mammograms ordered because of an abnormal finding are covered separately and do not count toward the yearly screening limit.
- Medicare Advantage plans must cover at least this same benefit, but some offer more frequent screening or lower costs — contact your plan to confirm.
- You must go to a Medicare-enrolled provider; mammograms at non-participating facilities may not be covered.
What counts as a screening mammogram versus a diagnostic one
The difference matters because it affects how often Medicare will pay. A screening mammogram is done on a woman with no breast symptoms and no known breast problem — it is routine cancer detection. Medicare covers one per calendar year (January through December) at no cost.
A diagnostic mammogram is ordered when a woman has a symptom (like a lump, pain, or discharge) or when a screening mammogram found something that needs closer look. Diagnostic mammograms take longer, use more images, and may include ultrasound or other imaging. Medicare covers these without the yearly limit because they are medically necessary — your doctor is investigating a specific concern, not doing routine screening.
If you have a screening mammogram and the radiologist finds an abnormality, the follow-up imaging is billed as diagnostic and is covered separately. You will not hit your yearly screening limit.
Where you can get a mammogram covered by Medicare
You must receive your mammogram at a facility that is enrolled in Medicare and meets federal quality standards. This includes hospital radiology departments, freestanding imaging centers, and some breast imaging clinics. Before you schedule, ask the facility to confirm they are a Medicare provider and that they will bill Medicare directly.
If you go to a facility that does not accept Medicare, you will likely have to pay the full cost out of pocket — Medicare will not reimburse you. Some facilities are "opt-out" providers, meaning they have chosen not to participate in Medicare; these providers can charge you whatever they wish, and Medicare will not pay any part of the bill.
Your primary care doctor or OB-GYN can refer you to a Medicare-enrolled mammography facility in your area. You can also search the Mammography Quality Standards Act (MQSA) database on the FDA website to find certified facilities near you and confirm their Medicare status by calling ahead.
What you pay out of pocket
For a screening mammogram, you pay nothing if you have met your Part B deductible and you go to a Medicare-enrolled provider. There is no copay, no coinsurance, and no deductible required for the screening itself.
For a diagnostic mammogram, you typically pay 20% of the Medicare-approved amount after you have met your yearly Part B deductible ($240 in 2024, though this amount changes each year). If you have not met your deductible yet that year, you pay the full deductible first, then 20% of the approved amount.
If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20% coinsurance on the diagnostic mammogram. If you have Medicaid in addition to Medicare, Medicaid may cover costs that Medicare does not. Check your policy documents or call your insurance company to understand your specific out-of-pocket responsibility.
How the calendar year limit works
Medicare's once-per-year screening mammogram benefit resets on January 1 each year. If you had a screening mammogram in November, you can have another one in January of the following year — they are in different calendar years, so both are covered.
If you have had a screening mammogram and want another one within the same calendar year, Medicare will not cover it unless your doctor orders it as a diagnostic mammogram (because of a symptom or abnormal finding). Some women ask their doctor whether a second screening is medically necessary; if the doctor documents a medical reason, it may be billed as diagnostic and covered.
Keep track of when you had your last screening mammogram so you know when you are may be able to access for the next covered one. If you are not sure, call your imaging facility and ask them to check your records.
What to ask your doctor before scheduling
Before you book a mammogram, ask your doctor whether it should be a screening or diagnostic mammogram. This determines whether it counts toward your yearly limit and what you will pay. If you have symptoms or a recent abnormal finding, make sure your doctor documents this so the facility bills it correctly as diagnostic.
Ask your doctor which Medicare-enrolled facilities they recommend in your area. Some doctors have preferred imaging partners they work with regularly. Confirm the facility accepts Medicare before you schedule.
If you have Medicare Advantage, ask your doctor whether your plan requires a referral or has any other rules about where you can go. Some plans require you to use in-network providers or to get prior approval before the mammogram.
When to contact Medicare or your insurance company
Contact Medicare (1-800-MEDICARE) if a facility tells you they will not accept Medicare for your screening mammogram, or if you receive a bill after a screening mammogram that should have been covered at no cost. Medicare can tell you whether a facility is enrolled and can help resolve billing disputes.
Contact your Medicare Advantage plan if you are unsure whether a mammogram is covered under your specific plan or what your out-of-pocket cost will be. Plans vary in their coverage details, and your plan's customer service line can give you exact information about your benefits.
If you receive a bill you believe is incorrect, do not ignore it. Call the facility's billing department and ask them to explain the charge. If it was a screening mammogram and you were billed, ask them to resubmit the claim to Medicare or correct the billing code.
Frequently Asked Questions
Can I get a mammogram more than once a year if my doctor thinks I need it?
Yes, if your doctor orders it as a diagnostic mammogram because you have a symptom or an abnormal finding from a previous mammogram. Diagnostic mammograms are not limited to once per year. If you want a second screening mammogram for routine cancer detection, Medicare will not cover it unless your doctor documents a medical reason to bill it as diagnostic.
Do I need a referral from my doctor to get a mammogram?
Original Medicare does not require a referral for a screening mammogram. You can call a Medicare-enrolled facility and schedule directly. However, if you have Medicare Advantage, your plan may require a referral — check your plan documents or call your plan to confirm.
What if I am under 40 — does Medicare cover mammograms?
Original Medicare does not cover routine screening mammograms for women under 40. However, if you are between 35 and 39, Medicare covers one baseline mammogram to establish a comparison for future screening. If you are under 35 and have symptoms or a family history of breast cancer, talk to your doctor about whether imaging is medically necessary — your doctor can order it, and Medicare may cover it as a diagnostic test.
Will my Medicare Advantage plan cover more mammograms than Original Medicare?
Some Medicare Advantage plans do offer additional mammogram coverage, such as screening every six months instead of once per year, or coverage for supplemental imaging like 3D mammography. Check your plan's summary of benefits or call your plan's customer service to learn what your specific coverage includes.
What happens if I go to a facility that is not Medicare-enrolled?
Medicare will not pay for a mammogram at a non-participating facility. You will receive a bill for the full cost and will have to pay it yourself. Always confirm that a facility accepts Medicare before you schedule.