
Medicare coverage
What does Medicare cover (and not cover)?Has your doctor recommended an MRI to help diagnose an illness or injury? Here's some helpful information about
Medicare Part B may cover 80% of the cost for a medically required magnetic resonance imaging (MRI) scan ordered by a doctor. However, both the doctor and the facility performing the scan must accept Medicare patients.
Let’s look at the standards Medicare uses to determine coverage for MRI scans, the typical cost of an MRI scan and how Medicare Advantage (MA) plans may help cover MRI costs.
Medicare typically covers MRI scans when your doctor determines that it’s medically required to reach a diagnosis. MRI scans are classified as “
To be sure that your MRI scan is covered, talk with your doctor about whether the MRI is medically necessary and ask them to be sure to refer you to an MRI facility that accepts Medicare.
Medicare Advantage plans, purchased through private insurers like Humana, are required by law to provide at minimum all of the benefits provided by Original Medicare Part A and Part B. If you’ve opted for an MA plan, contact your plan provider to confirm that your MRI scan will be covered.
Humana Medicare plans offer benefits beyond what Original Medicare covers. Explore all of the plans available in your area today!
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The actual cost of an MRI scan may change depending on the following factors:
MRI scans are not covered under Medicare if there is no prior authorization from a doctor or if the order was not received from your healthcare provider.
Additionally, if the facility providing the MRI scan does not accept Medicare, the service will not be covered. It’s important to confirm that the facility you visit accepts Medicare so you can avoid additional out-of-pocket costs.
All Medicare Advantage plans are required by law to provide all of the benefits offered by Original Medicare Part A and Part B. In addition, unlike Original Medicare, all Medicare Advantage plans include an annual maximum for your out-of-pocket costs. Once you’ve reached that maximum out-of-pocket limit, you’ll pay nothing for in-network covered services for the rest of your plan year. (In 2024, the maximum is $8,850, but many plans choose to offer lower limits.)
Medicare Advantage plans may also help with arranging and paying for transportation costs to an MRI scanning facility.
To learn more,
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