How does Medicare Part B handle coverage for preventative screenings like mammograms?

Answered by 3 licensed agents

Medicare Part B covers preventive screenings like mammograms as part of its focus on early detection and health maintenance, with specific rules on frequency, cost, and eligibility. Here’s how it works:

Screening Mammograms: These are covered for women aged 40 and older to detect breast cancer early, before symptoms appear.

Frequency: Part B fully covers one screening mammogram every 12 months (anytime after 11 months from your last one). If you’re new to Medicare, you also get a baseline mammogram covered between ages 35–39.

Cost: There’s no out-of-pocket cost—no coinsurance, copayment, or Part B deductible—as long as the provider accepts Medicare assignment (agrees to Medicare’s payment rates). This applies to 2D and 3D (tomosynthesis) screenings, though 3D coverage was clarified in updates around 2018 to match evolving standards.

Diagnostic Mammograms: If a screening finds something abnormal or you have symptoms (like a lump), Part B covers diagnostic mammograms to investigate further.

Frequency: No strict limit—covered as medically necessary, which could mean multiple in a year if your doctor orders them.

Cost: After meeting the Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount. There’s no cap on how many are covered, but each one triggers that 20% coinsurance unless you have a Medigap plan to offset it.

Key Details: The mammogram must be done at a Medicare-approved facility (like a radiology center or hospital outpatient department). If it’s bundled with other services (e.g., a biopsy), additional costs might apply under Part B’s standard rules. Preventive coverage assumes you’re symptom-free—once it’s diagnostic, it shifts to a treatment framework.

This setup reflects Part B’s broader approach to preventive care: full coverage for annual screenings to catch issues early, with cost-sharing kicking in when it’s about diagnosis or follow-up. It’s a balance between encouraging checkups and managing expenses when care escalates.

Answered by Charles Fletcher on March 24, 2025

Agent Licensed in WA, AZ, ID, NV & TN

Answered by Charles Fletcher Medicare Insurance Agent
Medicare Part B pays for many preventative screenings. Be sure to check with your provider if you have a question about a specific screening you are interested in.

This booklet from CMS also explains quite about about preventative screening. Download it from CMS here: https://www.medicare.gov/publications/10110-your-guide-to-medicare-preventive-services.pdf

Good Luck.

Answered by Bill Filer on March 31, 2025

Agent Licensed in MO, GA, KS & TN

Answered by Bill Filer Medicare Insurance Agent
For most preventative screenings, Medicare covers it at no cost to you! This is to incentivize you to stay on top of your health. A lot of times Medicare Advantage plans will even reward you for taking care of these preventative screenings.

Answered by Keaton Lewis on March 31, 2025

Broker Licensed in ID, AZ, CA & 11 other states

Answered by Keaton Lewis Medicare Insurance Agent

Tags: Coverage Medicare Part B

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