Breast cancer is one of the leading causes of death from cancer among women over the age of 40. That makes it an especially pressing issue for women as they get older. Mammograms are one of the most important screening tools available for breast cancer. Medicare coverage of mammograms is a natural concern for many Medicare recipients, aged 65 or older or under the age of 65 who qualify due to disability.
What Is a Mammogram?
A mammogram is a set of x-rays performed on each breast. Each breast has a top view and a side view x-ray taken for the purpose of identifying breast cancer as early as possible. Early identification greatly increases the chances of successful treatment and post-treatment survival.
The actual x-rays are taken by a technician. The breast is squeezed between two plates to flatten it prior to the image being taken. Once all four x-rays are taken and exposed, the technician checks the images to make sure they are clear enough to read. If an error occurred, one or more additional x-rays will be taken. If the images are clear, you’ll be able to leave.
The x-rays are passed along to a radiologist who checks the images for signs of characteristic masses. If the radiologist sees a cause for concern, they may contact you and your doctor for follow-up exams.
Medicare Coverage for Mammograms
Mammograms receive coverage under Medicare Part B, although there are some basic limitations on the coverage. For woman between the ages of 35 and 39, Part B will cover one baseline mammogram. Women over 40 can get a screening mammogram once per 12 months. You can get a diagnostic mammogram as frequently as your doctor deems it medically necessary for you to do so.
For example, if your doctor spots something on a screening they are concerned with, they may recommend you get a diagnostic mammogram every three or four months as a precautionary measure. Under those conditions, Medicare typically approves coverage as medically necessary.
Mammogram Costs Under Medicare
Medicare Part B provides coverage for screening and diagnostic mammograms. You can get screening mammograms once every 12 months at no cost if the doctor or facility accepts assignment. Assuming your doctor accepts assignment, you have no costs for a screening mammogram. If you require a diagnostic mammogram, you will likely pay 20% for each mammogram and the Part B deductible will apply.
Breast cancer is a very serious and often fatal condition when it isn’t caught and treated early. It becomes more common after the age of 40, which is why women are strongly encouraged to receive mammograms every year starting at that age.