Original Medicare and Medicare Advantage plans cover mammograms for both screening and diagnostic purposes. However, levels of coverage and cost may vary based on the type of mammogram and Medicare plan.
Both Original Medicare, which includes parts A and B, and Medicare Advantage (Part C) cover screening mammograms at 100%. They also cover diagnostic mammograms, but a person may need to pay any deductibles, coinsurances, and copayments that apply.
Read on to learn more about mammogram coverage under Original Medicare and Medicare Advantage plans. This article will also look at who may need a mammogram, the types of mammograms available, and what to expect during the procedure.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this 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.
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), covers baseline and screening mammograms for females but not for males.
This plan also covers as many diagnostic mammograms as a doctor considers necessary, and these are available for both males and females.
Medicare covers diagnostic mammograms if:
- a person has a history of breast cancer
- they have signs and symptoms that indicate breast disease
- a person’s doctor believes that a mammogram is necessary
Medicare Part B coverage
Medicare Part B covers one baseline mammogram for females ages 35 to 39 years and annual screening mammograms for females ages 40 years and over.
Medicare Part B also covers diagnostic mammograms and will cover more than one per year if a doctor decides that it is medically necessary.
Medicare Advantage coverage
Medicare Advantage plans include the same coverage as Original Medicare, along with certain other benefits based on the specific policy.
If someone meets the Medicare eligibility requirements, Medicare Advantage plans will cover the cost of baseline and screening mammograms.
Medicare Advantage plans also cover diagnostic mammograms.
Under Medicare Part B, screening and baseline mammographs are free when administered by providers who accept Medicare. Diagnostic mammograms are subject to the costs associated with Part B.
In 2025, Medicare Part B has a monthly premium of $185 and an annual deductible of $257. After a person reaches their deductible amount, they are responsible for paying 20% of the Medicare-approved cost of their diagnostic mammogram.
Costs for mammography under a Medicare Advantage plan may differ based on location and policy. As with Original Medicare, baseline and screening mammograms are available at no charge. However, a person must use an in-network provider.
As with Part B, Medicare Advantage plans do not cover the entire cost of diagnostic mammograms. If a person visits an in-network provider, the plan pays part of the cost, but deductibles, copayments, and coinsurances will apply. Always check with the plan to ensure that a doctor is in its network.
Screening mammograms are X-rays of the breast. Females who do not have symptoms or signs of breast disease usually undergo screening mammograms. The purpose of the X-rays is for the early detection of cancer.
Below are the
- Females ages 40 to 44 years may consider getting one per year.
- Females ages 45 to 54 years should get one per year.
- Females ages 55 years and older may switch to getting one every 2 years, or they may carry on with getting one each year.
- Screenings should continue for as long as a female is in good health and expects to live for at least 10 more years.
A person should consider talking with their doctor about when it is best to start screening mammograms. The doctor will base their recommendation on a person’s individual risk factors and family history.
Although there is a difference between
The sections below will look at the similarities and differences in more detail.
Screening mammograms
Screenings usually consist of taking two or more X-ray images of each breast.
These images can show tumors a person may not be able to feel. They can also reveal tiny calcium deposits that can sometimes indicate the presence of cancer.
Diagnostic mammograms
Diagnostic mammograms involve taking a higher number of images, with different views of the breast from various angles.
Doctors use diagnostic X-rays to assess changes that may have been apparent in a screening mammogram. They also use these images to view breast tissue when a screening mammogram is hard to obtain, such as in a person with a breast implant.
Doctors do not tend to advise regular self-exams of the breasts for cancer detection, according to the
Instead, the medical community recommends mammograms and clinical exams for screening.
A person who performs self-exams should be mindful of several factors that can cause changes in the breasts. These include:
- menopause
- aging
- pregnancy
- the monthly menstrual cycle
It is typical for breasts to feel a little lumpy, but if a person detects any unusual changes, they may wish to consider seeking medical advice.
The procedure for a mammogram is simple, but many people find it uncomfortable. Some people also experience some pain.
During a mammogram, a person will stand in front of an X-ray machine. A technologist will place the individual’s breast on a plastic plate. Another plate, above, will press down on the breast to flatten it. The plates hold the breast still while the technologist takes the X-ray. They will then repeat these steps to obtain a side view of the breast.
The
- On the day, avoid wearing perfume, deodorant, or powder, all of which can appear as white spots on the X-ray.
- Avoid undergoing a mammogram the week before or during menstruation, as the breasts may be swollen during this time.
- To avoid having to undress from the waist down, a person may wish to wear a top with pants or a skirt rather than a dress.
Most people get a report on their mammogram results within a few weeks of the procedure. A person who does not receive the report within
If a mammogram report shows an irregularity, it is important to remember that this does not necessarily indicate cancer.
A person with an abnormal result may need to undergo additional tests, and a doctor may also refer them to a breast specialist.
Medicare Part B and Medicare Advantage will pay for 100% of the cost of a screening mammogram for people who meet the age criteria.
To get screening mammograms for free, a person enrolled in a Medicare Advantage plan must meet the additional requirement of using an in-network provider.
Both plans also cover diagnostic mammograms, but deductibles, copayments, and coinsurance may apply. Coverage includes as many diagnostic mammograms as a doctor deems necessary.
A note on insurance
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