I've heard about new AI-powered diagnostic tools for early disease detection. Does Medicare cover any of these cutting-edge technologies?

Answered by 8 licensed agents

Yes, Medicare is increasingly covering AI diagnostic tools and services. AI is becoming a major player in all aspects of our lives and continues to grow in knowledge every day. It is being used to help diagnose people’s healthcare problems. However, it’s in its early stage and still needs to have the oversight of humans' approval before it can be accepted as a proper diagnosis.

Answered by Larry Dalton on April 13, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent
MEdicare covers traditional medical procedures. Your Supplement or MAPD plan will cover

diagnostic tools. It's the person doing the testing to see if AI technology is covered.

Answered by Aaron Solomon on April 25, 2025

Broker Licensed in OH, LA & TX

Answered by Aaron Solomon Medicare Insurance Agent
As of Nov. 24th 2024 Medicare Covers AI-Powered diagnostic tools to detect Coronary Artery Disease when "it is reasonable and medically necessary as a diagnostic study” and also patients present acute or stable chest pain.

Answered by Robert Helmkamp II on April 10, 2025

Broker Licensed in AZ

Answered by Robert Helmkamp II Medicare Insurance Agent
​Yes, Medicare has begun covering several AI-powered diagnostic tools that aid in early disease detection, particularly in areas like cardiovascular health and cancer surveillance.

Answered by Vachik Chakhbazian on April 12, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent
New senate bill would create Medicare payment pathway for AI-enabled devices. The Health Tech Investment Act proposes a Medicare payment system for FDA-cleared AI-enabled devices, facilitating their clinical integration. The Health Tech Investment Act (S. 1399), introduced by Sen. Mike Rounds (R-S.D.) and Sen. Martin Heinrich (D-N.M.), would establish a predictable Medicare payment system for AI-enabled medical devices that have been cleared by the FDA. These devices include algorithm-based healthcare services used in diagnostics, imaging, and other areas of clinical care.

Answered by Robert Baez on April 11, 2025

Agent Licensed in IL

Answered by Robert Baez Medicare Insurance Agent
I have not seen any notification from Medicare for this specific question. I would start with your Doctor and have them ask for prior approval to your insurance carrier for the specific AI test that your doctor has access to.

Answered by Louanne Allison on April 23, 2025

Agent Licensed in MI, FL, IL & OH, TN, TX & UT

Answered by Louanne Allison Medicare Insurance Agent
Yes, Medicare has begun covering certain AI-powered diagnostic tools, particularly those that have received FDA clearance and demonstrate significant clinical benefits. For instance, AI-enabled coronary plaque analysis tools, such as those using CT-based quantitative coronary topography (AI-QCT), are covered when deemed medically necessary for diagnosing conditions like coronary artery disease. Additionally, AI algorithms for diabetic retinopathy screening have seen increasing Medicare claims, indicating growing adoption in clinical settings.​

However, coverage is not universal for all AI diagnostic tools. Medicare Advantage plans may also utilize AI technologies, but they must adhere to regulations ensuring that coverage decisions are based on individual patient circumstances and medical necessity, not solely on algorithmic recommendations.​

It's important to note that while Medicare is expanding its coverage of AI diagnostics, the inclusion of specific tools depends on factors like FDA approval, demonstrated clinical efficacy, and adherence to Medicare's coverage criteria.​

If you're considering an AI-powered diagnostic tool, it's advisable to consult with your healthcare provider and Medicare plan administrator to determine if the specific technology is covered under your plan.

Answered by Chuck Winslow on April 28, 2025

Agent Licensed in IN

Answered by Chuck Winslow Medicare Insurance Agent
To my knowledge not as of yet, however, insurance carriers are starting to use AI algorithms to see what their clients are searching for. You may not have a diagnosis, but carriers may soon be able to see if you anticipate you have a condition, and thereby affecting your premiums.

Answered by Aaron Green on April 11, 2025

Broker Licensed in IA, KS, MO & NE

Answered by Aaron Green Medicare Insurance Agent

Tags: Coverage Medicare Part B

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