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

Question

Charles Fletcher · Accepted Answer

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.

Nikki Rowland · Answer

Medicare Part B covers many preventive services, including screening mammograms, to help detect diseases early when they’re most treatable.

Kathryn Zekas · Answer

Once you are on Medicare, many preventive screenings are FULLY covered, such as mammograms, pap smears, colonoscopies, psa tests, yearly wellness checkups and more! This is a guide to some of the screenings and how frequently Medicare will cover them.
https://www.medicare.gov/publications/10110-your-guide-to-medicare-preventive-services.pdf

Bill Filer · Answer

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.

Kim Cotten · Answer

Medicare Part B covers preventive screenings like mammograms to help detect health issues early, often at no cost to the beneficiary if certain conditions are met. Your doctor should verify coverage before proceeding with all types of preventative screenings.

Answered by Richard Balistreri on May 19, 2025

Agent Licensed in MO, AZ, FL & 7 other states

Answered by Richard Balistreri Medicare Insurance Agent

Keaton Lewis · Answer

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

Steven Bleicher · Answer

It is handled very well by both Part A (Hospital Inpatient) or through Part B (Outpatient). 80% is covered by Medicare & ALL the rest by a Medigap.

Timothy Brown · Answer

Medicare Part B covers a wide range of preventive health screenings, including cancer screenings, diabetes screenings, and screenings for other conditions, with many covered at no cost to the beneficiary

Answered by Timothy Brown on April 8, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

Original Medicare Part B, Medical Insurance,
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.

Cody Brown · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/how-does-medicare-part-b-handle-coverage-for-preventative-screenings-like-mammograms#cody-brown

Katheryn Evans · Answer

Medicare allows an annual preventive care mammogram once a year for those over 40 years old. 

Diagnostic mammograms, if medically necessary, may be covered more than once a year. 

This is the link to all Medicare covered Preventative benefits. https://www.medicare.gov/coverage/preventive-screening-services

Fred Manas · Answer

Medicare Part B covers mammogram screenings as a preventive service, with no out-of-pocket costs for those who meet the eligibility requirements and have a provider who accepts assignment. Specifically, one baseline mammogram is covered for women between the ages of 35 and 39, and annual screening mammograms are covered for women 40 and older. 
Here's a more detailed breakdown:
Coverage:
Medicare Part B covers both screening mammograms (for women 40 and older) and diagnostic mammograms if medically necessary. 
Cost:
If your doctor or healthcare provider accepts assignment, you won't pay a deductible, copayment, or coinsurance for these screenings. 
Eligibility:
To be eligible for these preventive services, you need to be enrolled in Medicare Part B. 
Frequency:
Women aged 40 and older are eligible for one screening mammogram every 12 months. 
Additional services:
Medicare Part B also covers a variety of other preventive services, including vaccines, annual wellness visits, and screenings for other types of cancer.

David Christian · Answer

Mammograms fall under preventive care.  Preventive care is administered with no costs to the patient!

Ross Landon · Answer

It covers a Woman age 40 plus once a year without cost if your Dr accepts Medicare Assignment, just ask them, they will tell you!  

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!

Barbara Barnes, CMIP® · Answer

Yes, but you always need to have a discussion with your doctor when preventive tests are ordered, to be sure that they are coded for claims payment as ‘preventative’. 

If you’ve had a prior diagnosis of abnormal breast tissue, for instance, future mammograms that are performed to keep an eye on that issue will no longer be ‘preventative’ but rather ‘diagnostic’ in nature. 

The same is true of an A1c test for diabetes. As long as your A1c is normal, future tests to make sure that you haven’t developed diabetes should be coded as ‘preventative’ but as soon as you have a reading that indicates diabetes or even ore-diabetes, future tests will be diagnostic. 

Preventative tests are generally paid at 100% by Original Medicare and Medicare Advantage while diagnostic tests are generally subject to your deductible and paid at 80% with Original Medicare, or subject to the plan benefits and copayments with Medicare Advantage.

It’s much easier to check the codes before the test is done than it is to have them changed afterwards. Busy doctors can easily make errors in this type of order, so asking them before they write the order is a good idea.

Richard Balistreri · Answer

Medicare Part B covers preventive screenings like mammograms to help detect health issues early, often at no cost to the beneficiary if certain conditions are met. Your doctor should verify coverage before proceeding with all types of preventative screenings.

Answered by Richard Balistreri on May 19, 2025

Agent Licensed in MO, AZ, FL & 7 other states

Ingrid Kollmann · Answer

For diagnostic mammograms, Part B typically covers 80% of the Medicare-approved amount after meeting the deductible.

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

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

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