Medicare makes breast cancer screening free for women who qualify. Here's exactly what's covered.
How does Medicare cover mammograms?
Medicare Part B covers screening mammograms to check for breast cancer before symptoms appear. Women 40 and older can get one screening mammogram every 12 months at no cost, you pay nothing and the Part B deductible doesn't apply, as long as your provider accepts Medicare assignment. Medicare also covers one baseline mammogram for women between 35 and 39. These free screenings are an important preventive benefit, since early detection greatly improves outcomes. Coverage applies to standard mammography and, where used, digital mammography. To make sure you're getting your covered screening and using a provider that accepts assignment, call 1-800-MEDIGAP at 1-800-633-4427.
Screening vs. diagnostic mammograms
There's an important distinction. A screening mammogram is a routine check with no symptoms, and Medicare covers it at $0 once a year. A diagnostic mammogram is ordered when you have symptoms or an abnormal screening result and the doctor needs a closer look. Diagnostic mammograms are also covered, but you pay 20% of the Medicare-approved amount after your Part B deductible. A Medigap plan can cover that 20% coinsurance on diagnostic imaging. Knowing which type you're getting helps you anticipate costs. To understand your breast health coverage and lower any out-of-pocket costs, call 1-800-MEDIGAP for free help.