One of the most valuable diagnostic tools that physicians and health care providers have access to is an MRI scan. MRI stands for magnetic resonance imaging and this aids physicians in determining the difference between tissue types in the body. An MRI helps diagnose certain conditions such as stroke, brain injury or aneurysm, or multiple sclerosis. It also helps physicians detect tumors or other abnormalities in organs, bones, and joints.
If your doctor suggests that you have an MRI scan, you need to know whether your Medicare insurance plan covers the cost.
What Medicare Coverage Includes MRI Scans?
Most Medicare recipients choose to get their benefits through Original Medicare or Medicare Advantage. Original Medicare offers Part A (hospital insurance), and Part B (medical insurance). Most people automatically are enrolled in Part A when they turn 65 as long as they paid taxes while working for a certain period of time. Part B is optional coverage, but most people enroll when they are first eligible to avoid paying late enrollment penalties later. Medicare Advantage plan, or Medicare Part C, is offered through private companies that contract with Medicare to provide your Part A and Part B benefits. Many MA plans include additional coverage, including prescription drug coverage, annual out-of-pocket maximums, and even fitness club memberships.
MRI scans are categorized as diagnostic non-laboratory tests. The costs of these tests are covered by Medicare Part B. Medicare coverage takes care of 80 percent of the authorized costs, but you will be responsible for paying the Part B deductible. For 2019, the deductible is $185.00. Even if you have Medicare Part B or are enrolled in a Medicare Advantage plan, you must meet some additional requirements for Medicare to pay for the cost of the scan. These requirements include the following criteria:
- The MRI must be prescribed by your doctor or health care provider as part of the treatment for a medical issue.
- All parties involved in the procedure, (i.e. the doctor who prescribes the
MRI and the provider administering the MRI) must accept Medicare assignment.
This is the only way you can ensure that you receive the maximum coverage
available under your plan.
Medicare Part A does not cover the cost of an MRI unless you are an in-hospital patient and your physician has prescribed it. In this case, Part A will cover the cost, but you will have to pay the deductible.
What Factors Influence the Cost of an MRI scan?
In the United States, the average cost of an MRI is around $2,600.00. Prices can range greatly, between a few hundred to several thousand dollars. Original Medicare Part B does take care of 80 percent of the final cost, but that means you still must pay 20 percent out-of-pocket, in most cases.
The main cost factor is the type of MRI exam your doctor has prescribed, and the body part being tested. For example, if an Extremity MRI is used to check for arthritis or bone fractures, this procedure is less expensive than one using a traditional, or open MRI to scan the brain or spine.
Another factor affecting MRI pricing is the location of the facility. A clinic that specializes in MRI examinations is generally less expensive than a hospital. Their prices depend on their overhead and the number of patients, as well as the type of equipment they have.
While your physician may suggest a facility, you can choose one yourself. There may be more than one in your area making it worth your time to check prices and whether they accept Medicare assignment.
Finally, there may be some additional charges that raise the total cost: sedatives for claustrophobia, an additional reading by a radiologist, or special dyes or contrasts administered to name a few. Make sure that you receive an itemized bill, so you are aware of any additional costs.
An MRI scan is a painless and non-invasive exam that provides invaluable diagnostic information helping your physician give you optimum care. If you are enrolled in a Medicare Advantage plan, check with your plan directly to find out your exact costs for an MRI.