Does Medicare cover mammograms?

What types of mammograms does Medicare cover?

Medicare Part B covers baseline, screening and diagnostic mammograms, which are X-ray pictures of the breast that check for breast cancer:

• A baseline mammogram, usually your first, creates a record of your breast tissue that's compared to all future mammograms.
• A screening mammogram monitors your breast health every year.
• A diagnostic mammogram investigates abnormalities, including symptoms or signs of breast cancer.

Who qualifies, and how often does Medicare cover a mammogram?

Who qualifies and how often Medicare Part B pays depend on the type of mammogram:

• Baseline mammogram: if you're a woman between 35 and 39, once in your lifetime.
• Screening mammogram: if you're a woman 40 or older, once every 12 months.
• Diagnostic mammogram: if it's medically necessary, and more often than once a year if medically necessary.

What do I pay for a mammogram with Medicare?

You pay nothing for a baseline or screening mammogram if your provider accepts assignment, which means the provider agrees to accept the payment amount Medicare approves for the service and not to bill you for more than the Medicare deductible and coinsurance.

For a diagnostic mammogram, you pay 20% of the Medicare-approved amount after you meet the Part B deductible ($283 in 2026). What you owe can also depend on other insurance you have, how much your doctor charges, whether your doctor accepts assignment, and the type of facility where you get the test, so ask your provider what the test will cost.

Does Medicare cover a breast ultrasound?

Medicare covers a breast ultrasound only when it's medically necessary and your health care provider orders it. Your doctor may order a breast ultrasound after a mammogram to check specific areas of your breast. Medically necessary means services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms that meet accepted standards of medicine.

What other breast and women's cancer screenings does Medicare cover?

Medicare Part B covers Pap tests and pelvic exams to check for cervical and vaginal cancers, and as part of the pelvic exam, Part B covers a clinical breast exam to check for breast cancer. Part B covers these screenings once every 24 months in most cases, or once every 12 months if you're at high risk for cervical or vaginal cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months. You pay nothing for the Pap test, the pelvic exam and the breast exam if your provider accepts assignment.

Does Medicare Advantage or Medigap change this?

Medicare Advantage plans must give you at least the same coverage as Original Medicare, but a plan may have different rules, like using doctors in the plan's network, and costs vary by plan. See how Medicare Advantage differs from Original Medicare.

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private insurance company to help pay your share of costs in Original Medicare, like coinsurance and deductibles. You can only buy Medigap if you have Original Medicare.