Does Medicare Cover 3-D Mammograms?
- February 18, 2021
Yes, Medicare Part B may cover 3-D screening mammograms once every 12 months for women 40 or older, the same way it covers 2-D screening mammograms. As long as your provider accepts Medicare assignment, you don't pay anything for your annual 3-D screening mammogram.
Medicare Advantage (Part C) plans 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.
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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 $198 per year in 2020).
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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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
