Medicare does cover MRI scans if your doctor deems them medically necessary in order to diagnose an illness or condition. This guide will take a look at how and when an MRI scan may be covered by Medicare and the costs you can expect to pay.
Medicare Advantage plans (Medicare Part C) cover eligible MRI scans in the same way that Original Medicare (Part A and Part B) does. Many Medicare Advantage plans also offer benefits not covered by Original Medicare, such as prescription drug coverage and certain home health care services.
In order for an MRI (magnetic resonance imaging) scan to be covered by Medicare, it must be ordered by your doctor or other health care provider who determines the procedure to be medically necessary as part of your treatment plan.
Additionally, the doctor prescribing the MRI and the health care provider administering the procedure must both accept Medicare assignment in order to ensure maximum coverage from Medicare.
If they do not accept Medicare assignment, you may be charged for up to 15 percent more than the Medicare-approved amount. This is called an excess Medicare charge.
Your MRI will typically be covered by Medicare Part B medical insurance. The cost of your MRI (and your cost for other similar scans, such as CT scans, EKGs, X-rays and PET scans) will depend on whether or not you have met your annual Medicare Part B deductible.
The Medicare Part B deductible is $185 per year in 2019. Once you meet your Part B deductible, you will be responsible for paying the Part B coinsurance, which is typically 20 percent of the Medicare-approved amount of your MRI cost.
The cost of an MRI can vary depending on the provider or facility you visit.
One coverage option Medicare beneficiaries can consider is a Medicare Advantage (Medicare Part C) plan. Medicare Advantage plans are required by law to provide coverage for the same benefits as Medicare Part A and Part B (also called Original Medicare).
Did you know that some Medicare Advantage plans feature $0 monthly premiums? $0 premium plans may not be available in all locations, so it may help to speak with a licensed insurance agent who can help you compare plans that are available where you live, including plans that cover MRI scans.
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