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