Does Medicare Cover Mammograms?

Mammography is the process of using radiological procedures to examine the breast for tumors or cysts that could be cancerous. Medicare covers one annual mammogram screening for women age 40 and above. To be covered by Medicare, eleven full months must pass before another screening is performed. Women between the ages of 35 and 39 may receive one baseline mammogram screening. All mammograms should include a doctor’s explanation of the results.

Medicare also covers diagnostic mammograms for men and women, regardless of age, who have a personal history of breast cancer or a personal history of biopsy-proven benign breast disease, but currently do not have any signs of the cancer or disease. To be covered, these mammograms must be ordered by a doctor of medicine or osteopathy.

The following conditions apply to radiological mammograms covered by Medicare:

1. patient has signs or symptoms that demonstrate the need for a mammogram
2. patient has a history of breast cancer
3. doctor advises, based on a patient’s history and other significant factors, a mammogram for a patient that has no symptoms

Is a Mammogram Right for Me?

Mammograms accompanied with physical breast examinations, both breast self-examinations (BSE) and physician examinations, are the leading standards for detecting early breast cancer. But because of the risk of radiation exposure and the lack of ‘sensitivity’ of mammograms, alternative methods are constantly being explored. Please ask your physician about the best choice for you.

What are my costs?

Medicare Part B benefits pay for mammogram screening and diagnostic mammograms. You pay 20% of a Medicare-approved amount with no Part B deductible. If new digital technology is used, you will also be required to make a hospital outpatient copayment. Actual amounts you must pay may be higher if a doctor, health care provider or supplier does not accept assignment.