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

Question

Larry Dalton · Accepted Answer

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

Steven Bleicher · Answer

I would not count on anything AI in the near future until they are thoroughly reviewed by Medicare and legislation which has been passed by the Senate and the House of Representatives. In these cloudy times, nobody can answer this question with any certainty, I am very sorry to say!

Answered by Steven Bleicher on June 2, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Aaron Solomon · Answer

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.

Robert Helmkamp II · Answer

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

Fred Manas · Answer

Yes, Medicare is expanding its coverage of AI-powered diagnostic tools, particularly in areas like cardiac imaging and diabetes screening. While AI in healthcare is rapidly developing, not all AI-based tools are currently covered by Medicare. 
Specific examples of Medicare coverage:
AI-QCT and AI-CPA (Coronary Imaging):
.
Medicare has approved coverage for AI-enabled Quantitative Coronary Tomography (AI-QCT) and Coronary Plaque Analysis (AI-CPA) when used with Computed Tomography Angiography (CCTA) for detecting coronary artery disease. 
Diabetic Retinopathy Screening:
.
Medicare covers AI-based screening tools for diabetic retinopathy, allowing them to count towards quality measures and for payment. 
A1C Tests for Diabetes Screening:
.
Medicare now covers A1C tests for diabetes screening, not just for monitoring type 2 diabetes. 
AI-powered cancer evaluation:
.
There is a push for expanded Medicare coverage for cutting-edge devices, including AI-powered tools for cancer evaluation. 
Important Considerations:
Ongoing Development:
The use of AI in healthcare is rapidly evolving, and Medicare's coverage policies are adapting to the new technologies. 
Not All AI Tools are Covered:
While AI in medical imaging is becoming more integrated into clinical workflows, it's important to note that not all AI-powered diagnostic tools are currently covered by Medicare. 
Future of Medicare Coverage:
There's a movement to expand coverage for new medical devices and AI-powered tools, making it easier for patients to access these technologies. 
To find out specific coverage information for a particular AI-powered tool, it's recommended to:
Consult with your doctor or healthcare provider.
Check with your Medicare plan.
Visit the Medicare website for the latest information on coverage policies.

Vachik Chakhbazian · Answer

​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.

Gary Haft · Answer

AI is so new that I am not totally sure what Medicare will cover, but if Medicare approves of the claim submitted by your provider, then obviously Medicare will cover their portion and if you have a Medicare Supplement, then your supplement will pay its portion of the claim. Medicare pays 80% of what they approve and your supplement would pay 20% of the Medicare approved amount.

Answered by Gary Haft on May 26, 2025

Agent Licensed in FL, AL, DC & 9 other states

Answered by Gary Haft Medicare Insurance Agent

Robert Baez · Answer

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

Chuck Winslow · Answer

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.

Louanne Allison · Answer

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

Aaron Green · Answer

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

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

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

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