A mammogram is the best way to find breast cancer for most women of screening age.1 Original Medicare Part B (Medical Insurance) covers certain preventive services, including mammograms, but there are rules to know before scheduling a mammography.
There are 3 types of mammograms, and Part B covers them all:2
A baseline mammogram is your first mammogram. It’s used to detect early signs of breast cancer and will be used as a comparison for future mammograms.
Screening mammograms are preventive exams to check for new signs of breast cancer. They’re typically performed once a year for women 40 and older with no symptoms or signs of breast cancer and considered at average risk for breast cancer.
A diagnostic mammogram is used to look more closely at an abnormality in the breast tissue, such as a lump or a tumor. An x-ray picture of the breast will be taken to check for breast cancer. Diagnostic mammograms can also be used to follow up on a potential risk found during a screening mammogram.
Medicare covers a baseline mammogram once in a woman’s lifetime between ages 35-39. Screening mammograms are covered once every 12 months for women 40 and older. If you need a diagnostic mammogram, Medicare will cover as many as you need if they’re deemed medically necessary.3
There’s no cut-off age for Medicare coverage and mammograms. If you're enrolled in Original Medicare, Part B will pay for an annual screening mammogram and diagnostic mammograms if medically necessary.
Part B covers baseline and annual screening mammograms at 100% of the Medicare-approved amount if your doctor or health care provider accepts assignment. That means you pay $0 (no deductible or coinsurance) for one baseline mammogram between ages 35-39 and one screening mammogram each calendar year for women 40 and older.4
Diagnostic mammograms are covered at 80% of the Medicare-approved amount if you receive the service from a participating provider. That means you pay a 20% coinsurance after you meet your Part B deductible ($164.90 in 2023). What you pay out-of-pocket can depend on how much your doctor charges and other insurance you may have.5
Note: A Medicare Advantage (Part C) plan may help cover some of the costs of mammograms, such as deductibles and coinsurance.
Some Humana Medicare Advantage plans help pay for coinsurance and deductibles for mammograms. To learn more and view plans in your area, check out our Humana Medicare Advantage plans.