How does Medicare Part B handle coverage for preventative screenings like mammograms?
Answered by 8 licensed agents
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 Nikki Rowland on April 23, 2025
Broker Licensed in SC & NC
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 Keaton Lewis on March 31, 2025
Broker Licensed in ID, AZ, CA & 11 other states
Answered by Timothy Brown on April 8, 2025
Broker Licensed in PA, CT, DE & 15 other states
covers a baseline mammogram once in your lifetime. A woman between ages 35-39.
Screening mammograms once every 12 months if a woman ages 40 or older).
Diagnostic mammograms more frequently, if deemed high risk, than once a year, if medically necessary.
Source: www.medicare.gov
Thank you.
Answered by Andrew Zurbuch, MBA on April 22, 2025
Broker Licensed in IN, FL, KY, MO, OH & TN
Answered by David Christian on April 19, 2025
Broker Licensed in CA & TX
Diagnostic screenings are covered more often if medically necessary, which means your Dr must order them, then you’ll pay 20% of the medicare approved amount! With these, The Part B deductible applies first, which is $240 annually in 2025!
Answered by Ross Landon on April 24, 2025
Agent Licensed in UT
Tags: Coverage Medicare Part B
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