Medicare covers one screening mammogram per year for women 40 and older

Medicare Part B pays for one mammogram every 12 months if you are a woman age 40 or older. A screening mammogram is an X-ray of the breast to look for cancer when you have no symptoms. Medicare covers this at no cost to you — no copay, coinsurance, or deductible — as long as you see a provider who accepts Medicare.

If your doctor finds something that needs a closer look, that follow-up mammogram (called a diagnostic mammogram) is covered separately and is not counted against your one screening per year. Diagnostic mammograms also have no cost to you under Part B.

Key Takeaways

  • Medicare Part B covers one screening mammogram every 12 months for women age 40 and older at no cost.
  • If a screening finds something suspicious, the diagnostic mammogram to investigate it is covered separately and does not count toward your yearly limit.
  • You must go to a Medicare-enrolled provider for the coverage to explore; calling ahead to confirm they accept Medicare prevents surprises at billing time.
  • The 12-month period runs from the date of your last mammogram, not from January 1, so the timing depends on when you had your previous one.
  • If you are at higher risk for breast cancer, talk to your doctor about whether more frequent screening is medically necessary.

What counts as a screening versus a diagnostic mammogram

A screening mammogram is a routine X-ray of both breasts when you have no symptoms and no known breast problem. This is the one mammogram per year that Medicare covers. You typically schedule it at a mammography center, and the radiologist looks for any signs of cancer.

A diagnostic mammogram happens when your doctor wants to investigate something — a lump you felt, pain, nipple discharge, or an abnormality found on a screening. A diagnostic mammogram may include extra views, ultrasound, or other imaging. Medicare covers this separately, meaning it does not use up your one screening per year. If you have a diagnostic mammogram in January and then need a screening in December, both are covered.

The distinction matters for your coverage because Medicare's yearly limit applies only to screening mammograms. If your doctor orders a diagnostic mammogram, that is covered as a separate service.

How the 12-month period works

The 12 months runs from the date you had your last mammogram, not from the calendar year. If you had a mammogram on March 15, you can have another one covered starting March 15 of the next year. This means the timing is personal to you, not tied to January 1.

If you are unsure when your last mammogram was, call your doctor's office or the imaging center where you had it done. They can tell you the exact date and when you become due for the next one. Keeping a record yourself — writing the date in your calendar or health notebook — makes it straightforward to know when to schedule.

Some women schedule their annual mammogram on the same date each year to make it a habit. Others schedule it around a birthday or anniversary. The method does not matter as long as you know when you are due.

What you pay and where to go

If you have Original Medicare (Part A and Part B) and you see a provider who is enrolled with Medicare, you pay nothing for a screening mammogram. No deductible applies, and you do not have to meet your Part B deductible first. This is one of the preventive services Medicare covers at 100 percent.

If you have a Medicare Advantage plan (Part C), coverage for mammograms is the same — one per year at no cost — but you may have a different list of in-network providers. Check your plan's provider directory or call the plan to find a mammography center near you that is in-network.

Before you schedule, confirm that the facility accepts Medicare. You can ask when you call to book the appointment, or you can search the Medicare provider directory online at Medicare.gov. Asking takes 30 seconds and prevents a bill later.

When you might be due for more frequent screening

Medicare's standard coverage is one mammogram per year. However, if your doctor believes you are at higher risk for breast cancer — because of family history, a previous breast condition, or other medical factors — your doctor may recommend more frequent screening. In those cases, talk with your doctor about what they recommend and why.

If your doctor orders more frequent mammograms as medically necessary, Medicare may cover them, but this is decided on a case-by-case basis. Your doctor would need to document the medical reason. Do not assume that more frequent screening is automatically covered; instead, have the conversation with your doctor first, and then ask your doctor's office to check with Medicare about coverage before you schedule.

What happens if you need a biopsy after a mammogram

If a mammogram finds something that needs a biopsy — a small tissue sample taken for lab testing — that biopsy is a separate service and is covered by Medicare Part B. You pay nothing for the biopsy itself if you go to a Medicare-enrolled provider.

A biopsy may be done using a needle (less invasive) or in a surgical setting (more invasive), depending on what the radiologist found. Either way, Medicare covers it. If you are worried about cost, ask your doctor's office to confirm that the biopsy facility accepts Medicare before the procedure.

Keeping track of your mammogram schedule

The easiest way to stay on track is to write down the date of your mammogram and mark your calendar for 12 months later. You can also ask your doctor's office to send you a reminder when you are due. Many imaging centers offer reminder calls or emails, so ask when you schedule whether they provide this service.

If you switch doctors or move to a new area, bring your mammogram records with you. This helps your new doctor know your history and when you are due. You can request your records from the imaging center where you had the mammogram done.

Frequently Asked Questions

Do I have to wait a full 12 months between mammograms, or can I have one sooner?

You can have a mammogram sooner if your doctor orders it for a medical reason — for example, if you found a lump or have symptoms. That would be a diagnostic mammogram and is covered separately. Your next screening mammogram would still be due 12 months from your last screening, not from the diagnostic one.

What if I had a mammogram at a private clinic before I turned 65 and got Medicare?

Medicare's coverage starts when you enroll in Part B, usually at age 65. Any mammograms you had before Medicare began do not count toward Medicare's yearly limit. Your first Medicare-covered screening mammogram is due 12 months after you enroll in Part B, or sooner if your doctor orders a diagnostic one.

Does Medicare cover 3D mammograms?

Yes. A 3D mammogram (also called tomosynthesis) is covered by Medicare as a screening mammogram. It is newer technology that takes multiple images to create a three-dimensional picture of the breast. If your doctor recommends it or your imaging center offers it, Medicare covers it the same way as a standard mammogram — one per year at no cost.

What if my mammogram shows something but I cannot afford follow-up care?

Medicare covers diagnostic mammograms, biopsies, and other follow-up imaging at no cost to you. If you are concerned about affording treatment after a diagnosis, talk to your doctor's office about financial resources, payment plans, or community health programs that may help. Do not delay follow-up care because of cost concerns without exploring your options first.

Can I get a mammogram at any hospital or imaging center?

You can go to any facility that accepts Medicare, but it is smart to check first. Call ahead or search Medicare.gov to confirm the facility is Medicare-enrolled. If you go to a facility that does not accept Medicare, you may receive a bill. Asking takes one phone call and protects you.