For people with denser breast tissue, an ultrasound might deliver a more precise detection tool for tumors than a mammogram.
Medicare previously offered comparable coverage for breast ultrasounds as for mammograms. However, it now only covers breast ultrasounds in specific situations when doctors deem them medically necessary.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
In 2024, Medicare announced that it would no longer fully cover the cost of a breast ultrasound when a mammogram reveals no abnormalities and the only finding is dense tissue.
That said, Medicare Part B deems breast ultrasounds medically necessary in the following situations:
- diagnosing breast implant issues
- evaluating whether to perform radiation treatment
- evaluating breast tissue in people who are pregnant as well as those breastfeeding or chestfeeding
- needing to differentiate between different kinds of masses
- evaluating the stability of a mass that is difficult to see on a mammogram
Medicare may also approve an ultrasound without a preceding mammogram in certain situations, but only with a doctor’s order. Additionally, a person must undergo the procedure from a qualified medical technician or doctor.
For those with a Medicare Advantage (Part C) plan instead of Original Medicare (Parts A and B), this plan should also cover the screening.
Generally, people pay approximately $250 out of pocket for a breast ultrasound. That said, when Medicare Part B provides coverage, it covers 80% of the expense after the person meets the $257 deductible in 2025. The person then pays the remaining cost as coinsurance.
Additionally, Part B has a monthly premium of $185 or higher, depending on a person’s income. However, individuals can also enroll in a Medicare supplement plan (Medigap) to help them cover these costs.
If, on the other hand, they are enrolled in Part C, their premium, deductible, and coinsurance will depend on their plan. According to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Part C plans is around $17 in 2025. In addition, for enrollment in a Part C plan, a person still has to pay the Part B premium, though some Part C may cover this premium.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
