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Does Medicare cover mammograms?

Yes, Medicare covers mammograms under Part B, but coverage and costs vary based on the type of mammogram: baseline, screening or diagnostic.

A mammogram is an X-ray of the breast to detect cancer. You can receive an initial screening, also called a baseline mammogram, and annual screenings. Your doctor may order a more comprehensive diagnostic image, particularly if a lump in the breast or another indication of cancer is detected.

Breast cancer accounts for about 1 in 3 of all new cancers in women each year and is the second most common type of cancer for women in the United States. Skin cancer is first

The median age of women’s breast cancer diagnoses is 63 — half the cases occur earlier and half later. But a woman’s highest risk of developing breast cancer within the following 10 years happens in her 70s, according to the National Cancer Institute. A woman has a 1 in 8 chance of getting breast cancer in her lifetime.

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Medicare emphasizes early detection and will cover: 

  • One baseline mammogram for women 35 to 39 
  • One screening mammogram every year for women 40 and older 
  • More diagnostic mammograms each year for women or men if medically necessary  

Almost 14 percent of Medicare beneficiaries are younger than 65. Most become eligible for Medicare two years after they start receiving Social Security disability benefits.

How much do mammograms cost with Medicare?

Screening mammograms cost less under Medicare than diagnostic mammograms, which your doctor may prescribe if you have a lump or other signs of breast cancer. 

Medicare Part B covers screening mammograms, including baseline mammograms, as a free preventive service. You won’t pay a deductible or copayment for the screening as long as your doctor accepts Medicare assignment.

These preventive mammograms are for women with no symptoms or history of breast cancer. A physician’s referral is not required for a screening mammogram, which is performed using digital 2D or tomosynthesis 3D imaging. In women with dense breast tissue, tomosynthesis may be better at detecting cancer and lower the potential for false positives.

Women and men receive diagnostic mammograms if they show symptoms of breast disease, have a personal history of breast cancer or display other warning signs. Typically, doctors will order a diagnostic mammogram if they detect a lump in the breast or to follow up on a suspicious finding after a screening mammogram.

Screening and diagnostic mammograms are usually done on the same machine, but diagnostic mammograms often require additional images and a radiologist typically reads them immediately, according to Molly Guthrie, vice president of public policy and advocacy at the Susan G. Komen Foundation. 

Diagnostic mammograms are not a free preventive benefit, so they’re subject to a 20 percent copayment after you’ve met the Part B deductible. If your doctor deems a diagnostic mammogram is medically necessary, know that Medicare won’t limit your coverage to a once-a-year screening.

Does Medicare’s mammogram coverage have age limits?  

Medicare sets minimum ages for its coverage of baseline and screening mammograms:

  • Age 35 and 39 to receive one baseline mammogram
  • Age 40 to start receiving one screening mammogram yearly

Your doctor can order diagnostic mammograms at any age.

The American Cancer Society recommends that women with an average risk of breast cancer undergo regular screening mammography starting at age 45, with an opportunity to begin screening at 40. It recommends annual screenings until age 54, then every two years, with the option to have the screening every year, for women 55 and older. Screenings should continue as long as the woman is in good health and is expected to live at least 10 more years.  

The U.S. Preventive Services Task Force, an independent panel of experts that reports annually to Congress, has its own recommendations for preventive screenings based on age. It initially recommended regular annual mammograms at 50 but recently issued a draft that would change its guidance and lower the recommended start to age 40. It recommends mammograms every two years through age 74.  

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Keep in mind

Medicare Advantage plans have similar coverage for annual screenings if you go to an in-network provider. For diagnostic mammograms, the cost sharing may differ from original Medicare and the plan may have additional requirements, but coverage can’t be more restrictive than traditional Medicare.  

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