If you need an MRI scan, will your Medicare benefits cover the cost? Since an MRI can be expensive, it’s essential to know this ahead of time, so you don’t get a surprise later on. We’ll go over what an MRI is, why you’d get one, and whether or not Medicare will pay for it.
Defining an MRI Scan
An MRI scan is a Magnetic Resonance Imaging scan. You might get an MRI if your doctor wants to see detailed pictures of your tissues and organs. MRI scans are instrumental in diagnosing several health conditions. When you get your MRI, you lay inside of a long narrow cylindrical-shaped machine. Once the technician switches it on, you get surrounded by a strong magnetic field. Advanced MRI machines can give 3-D images, helping your physician diagnose and treat any medical issues discovered.
Every facility may have different MRI charges, and it depends on several factors that may include, the cost of the MRI machine, technologist fees, and how long the MRI lasts. It may also depend on the room the MRI machine is in. It has specific safety features to protect anyone outside from the MRI’s magnetic field. When your doctor orders an MRI, you will need to visit a facility approved by Medicare in order for Medicare to help cover the costs.
Will Medicare Cover a Knee MRI?
Medicare Part B may help cover the cost associated with an MRI scan under certain conditions. If you don’t meet the conditions, you may find yourself paying for the cost out of your pocket. Since an MRI can run upwards of $3,500, knowing whether or not you have to pay anything is essential before you have it.
- Medically Necessary – First, your doctor has to document that your MRI is a medically necessary procedure, and you need it to rule out problems or to help with your treatment. They’ll have to submit documentation to the prior authorization person at the medical facility where you have your MRI.
- Medicare Assignment – The healthcare provider that administers the MRI and the doctor that orders the MRI have to accept Medicare assignment. If either one of these parties don’t accept assignment, you could pay up to 15% more than the Medicare-approved price for the MRI or be responsible for the full amount.
What Medicare Benefits Cover Knee MRIs?
In this case, Medicare Part B will be responsible for covering the cost of your MRI. However, you will be responsible for paying for your deductible and copayment, just like you’d pay if you had a CT scan, X-ray, PET scan, or EKG. In 2019, the Part B deductible was $185. Additionally, you’ll have to pay your Part B coinsurance. Your coinsurance is 20% of the Medicare-approved knee MRI cost.
A Medigap or Medicare Supplement plan can cover some of the total Part B copayment and coinsurance amount and all of Part A’s coinsurance if you purchase supplemental insurance. Supplement plans go alongside Original Medicare insurance, and they don’t work with Medicare Advantage plans. This means your Medicare Supplement plan could cover that 20% coinsurance you’d owe out of pocket if you didn’t have it.
If you have a Medicare Advantage plan, this could help cover your knee MRI cost as well. These plans can offer additional benefits that Original Medicare doesn’t like vision or dental. It’s up to you to compare plans and see which ones work best for your situation.