Does Medicare Cover 3-D Mammograms?

Medicare Part B may cover 3-D screening mammograms once every 12 months for women age 40 or older, the same way it covers 2-D screening mammograms.

Medicare Advantage (Part C) plans may also cover 3-D mammograms in the same way they are covered by Original Medicare (Part A and Part B). Most Medicare Advantage plans also offer prescription drug coverage, which Original Medicare doesn’t offer.

A woman smiles as she talks with her doctor in the doctors office

Does Medicare cover mammograms after age 65?

If you are a Medicare beneficiary between ages 35-39  – meaning you qualify due to a disability or End-Stage Renal Disease (ESRD) – Medicare will cover one baseline mammogram for you. After that, Medicare will cover your annual screening mammogram once every 12 months.

Women age 40 and above are considered high risk, because the risk of breast cancer rises dramatically with age.1

Medicare will continue to cover your annual screening mammograms after you turn 65. Medicare will also cover diagnostic mammograms more frequently than once a year if your doctor determines it to be medically necessary. However, diagnostic mammograms are not considered a preventive service like a screening mammogram, so your Part B (or Medicare Advantage plan) deductible and coinsurance typically applies.

What mammograms will Medicare pay for?

Medicare will pay for your mammograms to check for breast cancer in the following ways:

  • You don’t pay anything for your annual 3-D screening mammograms, as long as your doctor or health care provider accepts Medicare assignment.

  • Medicare will help cover diagnostic mammograms more than once a year if they are considered medically necessary by a doctor.

    If this is the case in your situation, you will typically pay 20 percent of the Medicare-approved amount for your mammogram, once you meet your Part B deductible (which is $185 per year in 2019).

How much you pay for your mammograms can vary if you have a Medicare Advantage plan. Be sure to check with your plan provider and your doctor to find out how much your plan will cover.

Should I get tomosynthesis instead of just a mammogram?

A three-dimensional (3-D) mammogram may also be referred to as digital breast tomosynthesis (DBT).

You should speak with your doctor or health care provider to find out which type of mammogram (3-D or 2-D) they offer and which type might be right for you.

According to one study published in the Journal of the American Medicare Association, implementing 3-D mammography resulted in a 41 percent increase in the detection rate of invasive breast cancer.2

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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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

1 Shachar, S., et al. Breast Cancer in Women Older Than 80 Years. (Feb. 1, 2016). Journal of Oncology Practice 12(2), 123-132. doi: 10.1200/JOP.2015.010207.

2 Friedewald, S., et al. Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography. (June 25, 2014). JAMA, 311(24), 2499-2507. doi:10.1001/jama.2014.6095.