What Types Of Mammograms Are Covered By Medicare
There are two primary types of mammograms Medicare will cover.
Types of Mammograms Covered by Medicare
- Screening Mammography
- A radiologic procedure for women with no signs or symptoms of breast disease. This test is used for early detection of breast cancer and includes a physicians interpretation of the results. This test must include at least a two-view exposure of each breast to be covered by Medicare.
- Diagnostic Mammography
- A radiologic procedure for patients with signs and symptoms of breast disease, a family history of breast cancer, or a personal history of benign breast disease. It includes a physician’s interpretation of test results.
More specifically, there are conventional, digital and 3D mammograms. Medicare will cover these services so long as your doctor accepts Medicare.
Does Medicare Cover Mammograms If Youre 65 Or Older
There is no age limit for breast cancer screenings, and you should always book an annual mammogram. Studies show that women aged 60-69 who got mammograms regularly had a 33% lower risk of dying from breast cancer than women who did not get mammograms. Its important to make a plan with your health care provider and discuss any risk factors or personal history you may be aware of before booking.
Medicare Advantage Plans Cover Mammograms
Medicare Advantage plans must offer the same basic benefits that Original Medicare offers, including mammograms.
In addition to the standard hospital and medical benefits all Medicare plans must cover, most Medicare Advantage plans cover prescription drugs, vision, dental, hearing and other benefits that Original Medicare does not cover.
A licensed insurance agent can help you find Medicare Advantage plans in your area.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
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Does Medicare Cover A 3d Mammogram
According to Medicare.gov, Medicare will cover mammograms under your Part B coverage. This includes 3D mammograms, also known as digital breast tomosynthesis , at no additional charge. Medicare covers the following different types of mammograms:
- One baseline mammogram for women between the ages of 35-39
- One screening mammogram every 12 months for women 40 and over
- Diagnostic mammograms more often when medically necessary
Whether a diagnostic mammogram is medically necessary will be decided by your doctor. Since the other types are considered to be preventative care, they are covered automatically.
D Vs Regular Mammograms
During a regular mammogram, which is technically called a conventional digital mammography, the scanner takes two pictures of your breast, one from the top and one from the side. The images can be stored in your medical history and compared with later scans to spot any suspicious changes to your breast tissue over the years, which is sometimes a sign of breast cancer.
The more advanced 3D mammogram uses similar equipment, and the process is broadly the same while the images are being taken. The difference is that a 3D scan takes multiple images of the breast from multiple angles. These images are then combined into a single 3Dimensional picture that provides much more detail about the breast tissue than a 2D scan does.
This kind of scan can, under certain circumstances, identify cancer at an earlier stage than conventional digital mammography. It’s also helpful to monitor post-cancer breast tissue for early signs of recurrence and to develop a detailed picture of small changes in breast tissue that could be problematic.
Doctors sometimes ask for a 3D mammogram when you have an unusually high risk of breast cancer or when you have already had it, and they want to monitor your treatment and recovery.
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When Does Medicare Cover 3d Mammograms
Medicare does include mammograms as a covered test with no out-of-pocket expense to you if:
- You are getting a 2D mammogram as part of your annual screening
- Your doctor has authorized a 3D mammogram as part of the annual screening
- It is your first mammogram, or you have not had a mammogram for at least 11 months
Medicare Part B pays for 80% of the price of a diagnostic mammogram, which may leave you out of pocket for the remaining cost. This is billed to you at the Medicare-approved price, which is generally lower than the market price for diagnostic tests.
Be aware that a 3D mammogram is typically more expensive than a conventional 2D test, and so your total cost could be higher if you get this kind of mammogram.
Medicare does not pay for screening mammograms for women under age 35, even if they have Medicare for disability-related reasons. Medicare also does not pay any of the costs of a screening mammogram for male beneficiaries, even if they have the BRCA1/2 mutations associated with male breast cancer.
Conventional Medicare benefits do pay up to 80% of the cost of a diagnostic screening for men who may have developed breast cancer, but it is not included as part of their regular annual health screening.
How Does Medicare Cover Mammograms
If you are a woman enrolled in Original Medicare and you are age 40 or over, Part B will generally cover the allowable charges for one screening mammogram every 12 months so you have no charge. Your Part B deductible and coinsurance amounts may apply. Usually eleven full months must have elapsed since your last screening mammogram before Medicare will pay for another one.
If you are a Medicare beneficiary between the ages of 35 and 39, Part B will generally cover the allowable charges for one baseline mammogram prior to age 40.
If your doctor orders a diagnostic mammogram that is medically necessary for your care, Part B also covers 80% of the allowable charges after youâve met your deductible.
Individuals who are enrolled in a Medicare Advantage plan may also pay little or nothing out-of-pocket for mammograms. Some plans charge a small copayment or waive the deductible for screening tests like mammograms. Medicare Advantage plans must cover everything that Original Medicare covers , but they can and often do include additional benefits for members such as no-cost screening exams and even routine vision, hearing, and dental coverage. With a Medicare Advantage plan you must continue to pay your Part B premium.
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Q: Can Anyone Get A 3d Mammogram And Is It Covered By Insurance
A: Yes and yes, with some exceptions. Three-dimensional mammograms can be used for routine screening mammography. They are gaining popularity and are widely covered by most insurance providers, including Medicare and Medicaid.
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Many research studies show that 3D mammography technically called digital breast tomosynthesis offers better results than conventional 2D mammography. It may be particularly effective for women with dense breast tissue or who are at high risk for breast cancer.
3D mammograms can better pick up invasive cancers and avoid the false alarms common with 2D mammography, particularly when breast tissue is dense.
Both 2D and 3D mammograms use X-rays to create detailed images of your breast, in order to detect masses or other abnormalities.
But in 3D mammography, an X-ray tube moves in an arc around each breast, capturing multiple imaging slices at different angles. These images are sent to a computer and reconstructed, to create a 3D model of your breast tissue in 1-millimeter slices that the radiologist reviews.
For women, the comfort level for 3D mammograms is similar to that of 2D mammograms. After positioning your breast tissue, a technician gently compresses it between a plate and a comfort paddle. The gradual, even compression creates a sense of pressure.
Which Medicare Options Cover Mammograms
Medicare Part B covers medically necessary outpatient diagnostic and treatment services. You can get screened for breast cancer with Medicare coverage once a year. In 2022, the Medicare Part B deductible has an annual out-of-pocket cost of $233, which must be met before covering medically necessary services.
Medicare Part C, also known as Medicare Advantage plans, is a private insurance plan that offers more benefits than Original Medicare and provides all Medicare Part B coverage. Because of this, you will automatically receive coverage for your mammogram.
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Medicare Coverage For Breast Ultrasound
Medicare pays for tests it considers to be medically necessary. With that in mind, it is not surprising that Medicare covers breast ultrasounds for women with dense breasts, for women with an abnormal mammogram, for men at high risk, or for anyone who has symptoms.
However, unlike a screening mammogram, the test will not be free. Mammogram is the only screening test for breast cancer that has a $0 price tag. You will pay 20% toward the cost of a breast ultrasound, whether it is for screening or diagnostic purposes.
You may not have to pay for the test if you have a Medicare Supplement plan, also known as Medigap. These plans help pay for any out-of-pocket expenses that Medicare leaves behind.
If you pick a plan that covers the Part B coinsurance , the plan will pay the 20% for you. Plan F is no longer available to people new to Medicare, but if you were on this plan before 2020, this would cover the Part B coinsurance too. Plans K and L only cover 50% or 75% of your coinsurance.
Does Medicare Pay For Mammograms
A regular screening mammogram is just one of many preventive services for women covered by Medicare.
Mammograms are covered under Medicare Part B. Medicare Advantage plans cover screening mammograms as well.
Medicare will cover:
- One baseline mammogram for women between the ages of 35 and 39.
- One free screening mammogram every 12 months for women age 40 and older.
- Diagnostic mammograms more frequently than once a year when medically necessary.
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Does Medicare Cover Annual Breast Exams
A breast exam is another diagnostic breast cancer tool that can be used to detect lumps or other abnormalities within the breasts. Medicare Part B covers annual breast exams, separately from screening and diagnostic mammograms, as part of your pelvic exam. Medicare will cover a pelvic and breast exam once every 12-24 months, depending on your cervical and vaginal cancer risk.
What extra benefits and savings do you qualify for?
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How Many Mammograms Are Covered By Medicare Part B
Preventive care covered by Medicare Part B insurance includes a baseline mammogram in women 35-39 years old, screening mammograms once a year for women age 40 and over, and more than one diagnostic mammogram per year based if deemed medical necessary.
Are there any Medicare tests that are not covered?
Medicare coverage for many tests, items and services depends on where you live. This list only includes tests, items and services that are covered no matter where you live. If your test, item or service isnt listed, talk to your doctor or other health care provider.
Can a 3D mammogram be used to detect breast cancer?
A 3D mammogram can be more effective for someone at high risk for invasive breast cancer, as it detects minute changes that may signal a beginning malignancy, allowing it to be analyzed and treated earlier. The advanced technology of the 3D mammogram can achieve more effective images in very dense breast tissue or when breast implants are present.
How Often Does Medicare Pay For Mammograms
If youre under age 65 and on Medicare, Medicare will pay for one baseline mammogram when youre between 35 and 39 years old. Once youre 40, Medicare pays for a screening mammogram every year. When the doctor accepts assignment, you pay nothing for the screening.
If the test is diagnostic, youll pay 20% of the costs. The average cost of a diagnostic Mammogram with Medicare is around $170. But, depending on your area and if you have extra insurance, your costs could be different.
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Breast Cancer Screenings Are Important
There are 2 types of mammograms: screening and diagnostic. The 3D mammogram is a diagnostic mammogram, but many oncologists militate against it. From their standpoint, 3D mammograms are no more efficient than the 2D ones.
Medicare will cover a mammogram only if its a yearly, routine screening. If its a diagnostic, Medicare will not cover it. Other medical insurance programs shy away from paying for 3D mammograms, as well.
This is because so many oncologists have pointed out that they are as efficient as a simple 2D mammogram. Moreover, they mentioned that women expose themselves to a higher intake of radiation by undertaking 3D mammograms, given that these are done only as a combo with their 2D counterparts.
Paradoxically, this excessive subjection to radiation can cause breast cancer. Why would the combo mammogram be necessary? Its simple: theres not enough proof that the 3D mammogram is accurate enough on its own.
If youve ever stepped foot in a radiology center, you will have seen that the 3D mammogram was advertised everywhere as a better alternative to the 2D one.
How can that be when oncologists are all raging at the mere thought of women actually thinking that theyre doing themselves a favor by getting hit with huge doses of radiation?
How A Mammogram Checks For Breast Cancer
A mammogram uses an X-ray involving a very small dose of radiation to screen for abnormal cells or growths in the breast tissue. During this process, the breast is placed between 2 supports that are gently pressed together to give the X-ray a clear picture. You may experience some discomfort, but only for a few seconds each time.2 The entire procedure lasts only about 20 minutes. You can usually get a mammogram in an imaging center, some doctors offices or in a mobile breast cancer screening unit.
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Screening And Diagnostic Mammograms
Medicare Part B, which covers outpatient services, pays 100% for a screening mammogram an imaging technique that can detect some breast cancers every 12 months for women age 40 or older.
A diagnostic mammogram is sometimes indicated when a screening mammogram shows possible signs of cancer, or when your doctor has other reasons to suspect cancer. Youll owe 20% of the Medicare-approved charge after you pay the Part B deductible, which is $203 in 2021 . Youre covered for diagnostic mammograms more than once per year if medically necessary.
Types Of Mammograms Medicare Covers
There are three main types of mammograms to choose from when you are due for a mammogram:
- Conventional mammogram: A conventional mammogram takes 2-D black and white images of the breast. The doctor can view the images as they are taken to look for any deposits, lumps or other areas of concern.
- Digital mammogram: Similar to a conventional mammogram, the digital mammogram takes 2-D black and white images. With a digital mammogram, the images are entered directly into a computer, allowing the doctor to zoom and enhance the images.
- 3-D mammogram: A 3-D mammogram takes multiple images to produce a comprehensive 3-D view of the breast tissue. This type of mammogram has been shown to improve the diagnosis of cancer in dense breast tissues.
Medicare should cover the costs of both conventional and 3-D mammograms, however, not all providers offer 3-D mammograms.
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When Breast Cancer Screening With A Mammogram Is Not Enough
Rony Kampalath, MD, is board-certified in diagnostic radiology and previously worked as a primary care physician. He is an assistant professor at the University of California at Irvine Medical Center, where he also practices. Within the practice of radiology, he specializes in abdominal imaging.
Mammograms are considered the gold standard for breast cancer screening, but they are not 100% accurate. In some cases, other imaging studies are needed to determine if a biopsy is necessary to check for cancer.
Medicare covers screening mammograms for free. But breast ultrasounds are also recommended for many women, especially those with dense breast tissue.
This article will explain when Medicare pays for breast ultrasound and how much it will cost.
Verywell / Michela Buttignol
