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Medicare Coverage of Mammograms: What You Need to Know

3 mins read
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Mammograms play a crucial role in maintaining breast health, serving as a key tool for early detection of breast cancer. Regular screenings can greatly increase the chances of catching cancer in its early stages, making treatment more effective. For those aging and concerned about their breast health, knowing about mammogram services and their Medicare coverage is crucial.

This article provides a comprehensive overview of what Medicare covers for mammograms, the types of mammograms included, and how beneficiaries can access these vital services. Understanding these aspects helps ensure that individuals take full advantage of the healthcare benefits available to them.

Does Medicare Cover Mammograms?

Medicare does cover mammogram services, but it’s important to understand the specific types covered and the conditions that apply. This coverage ensures beneficiaries have access to these crucial screenings as part of their healthcare plan.

Under Medicare Part B, beneficiaries have access to different types of mammograms:

  • Baseline Mammogram: This is usually your first mammogram and acts as a reference for future screenings. Medicare covers one baseline mammogram for women between the ages of 35 and 39. This initial screening sets a crucial baseline for monitoring any changes in breast health over time.
  • Screening Mammograms: Conducted annually, these routine checks are for women aged 40 and above. They are preventive in nature, aiming to detect early signs of breast cancer, particularly when no symptoms are present. Medicare recognizes the importance of regular screenings in early cancer detection and therefore covers these mammograms once every 12 months.
  • Diagnostic Mammograms: When a screening mammogram or symptoms indicate a possible concern, healthcare providers use diagnostic mammograms for a more detailed examination. Medicare does not limit the age or frequency for diagnostic mammograms, covering them as often as they are medically necessary. These mammograms are pivotal in closely investigating any abnormalities and formulating an appropriate response if needed.

Understanding the conditions that dictate coverage of mammograms for beneficiaries is crucial. This knowledge ensures that individuals can effectively navigate their healthcare options under Medicare. Firstly, the healthcare provider must accept Medicare assignment for beneficiaries to receive full coverage benefits. While baseline and screening mammograms are fully covered by Medicare, diagnostic mammograms involve an out-of-pocket cost. Beneficiaries are responsible for 20% of the Medicare-approved amount for these services after meeting the annual Part B deductible, which is set at $240 in 2024.

This comprehensive coverage under Medicare Part B underscores the program’s commitment to preventive healthcare, allowing beneficiaries to access vital screenings that can lead to early detection and treatment of breast health issues. Understanding these coverage details helps beneficiaries navigate their healthcare options more effectively, ensuring they utilize the benefits available to them for maintaining optimal health.

Understanding Medicare Part B and Mammogram Coverage

Medicare Part B plays a crucial role in covering various medical services, including mammograms. This part of Medicare primarily covers outpatient services and is essential for those needing regular medical care without hospitalization. For beneficiaries looking to maintain their breast health, understanding Part B’s role in mammogram coverage is vital.

Eligibility for Medicare Part B generally starts at age 65, but it can also include younger individuals with specific disabilities or conditions. Enrollment in Part B is sometimes automatic, particularly for those already receiving Social Security benefits. Others may need to enroll manually during their Initial Enrollment Period, which typically starts three months before turning 65 and lasts for seven months.

Scheduling and accessing mammogram screenings under Medicare Part B is straightforward. Beneficiaries can arrange their mammogram appointments directly with healthcare providers that accept Medicare. It’s advisable to confirm with the provider that they accept Medicare assignment to ensure the screening is fully covered. Regular mammograms, as recommended by healthcare providers, are important for early detection and effective management of breast health.

At CoverRight, we’re dedicated to helping you navigate your Medicare options and ensure you have the coverage you need for essential healthcare services.


Is a referral required for a mammogram under Medicare?

No, a referral is not typically required for a mammogram under Medicare. Beneficiaries can directly schedule their mammogram screenings with a healthcare provider that accepts Medicare. However, it’s always a good practice to consult with your primary care physician for guidance on scheduling a mammogram.

What age is recommended for starting mammogram screenings under Medicare?

Medicare recommends starting routine mammogram screenings at age 40. Women between ages 35 and 39 are eligible for a baseline mammogram. Healthcare professionals typically advise women aged 40 and above to undergo regular annual screenings for early detection and treatment of breast cancer.

How often does Medicare cover mammograms?

Medicare covers screening mammograms once every 12 months for women aged 40 and older. For women between 35 and 39, Medicare provides coverage for one baseline mammogram. Medicare provides coverage for diagnostic mammograms whenever they are medically necessary. This applies to individuals of any age when symptoms or specific findings indicate the need for further examination.

At what age does Medicare stop covering mammograms?

Medicare continues to cover mammogram screenings for beneficiaries as long as they maintain their enrollment in the program. This policy provides ongoing access to these crucial health screenings for individuals of all ages.

Richard Chan

Richard is the Founder of CoverRight and based in New York. He is passionate about empowering consumers to take control of their health and finances. Prior to starting CoverRight, Richard had extensive experience working in financial services with over 8 years' experience in consumer lending and investment banking.

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