Mammograms use a mild X-ray to screen for bumps and other unusual features that may be early signs of breast cancer. Medicare coverage for mammograms exists as part of Original Medicare Part B. Some mammograms are free under this coverage, although costs may vary. A covered health benefit of Medicare, mammograms can help catch breast cancer before it becomes more serious.
What types of mammograms does Medicare cover?
There are three different types of mammograms covered by Medicare. Yearly screening mammograms play an important role in preventive care. Diagnostic mammograms, on the other hand, are performed when there may be an important response to signs of cancer. Each type may have a different purpose depending on when and why you get them.
Both 2D and 3D mammograms are covered if you have a Medicare Advantage plan.
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Baseline mammogram
A baseline mammogram is the very first mammogram a patient receives. This type of mammogram can be used as a reference point for future tests, so it plays an important role in catching early signs of breast cancer.
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Screening mammogram
A screening mammogram is a routine checkup on the breasts, and one of the most important preventive exams a woman can receive. Breast cancer screenings check for signs of breast cancer such as a lump in the breast or other unusual features. They are often performed once a year. New signs of breast cancer can be found by checking the screening mammogram against the results of a baseline mammogram.
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Diagnostic mammogram
Diagnostic mammograms are used when the risk of breast cancer is higher. If breast abnormalities like lumps in the breast are discovered during a breast exam, a diagnostic mammogram is performed to get more information. This test helps doctors decide on future care.
How often does Medicare pay for mammograms?
Medicare coverage for mammograms changes as you get older. Medicare Part B covers one baseline mammogram between the ages of 35 and 39 and one screening mammogram annually starting at age 40. If a diagnostic mammogram is required, part of the cost will be covered.
Does Medicare cover mammograms after age 65?
Yes, Medicare Part B will continue to cover one mammogram each year after 65. But are mammograms still necessary after age 65? They certainly are. Medicare mammogram coverage changes with age as the risks of breast cancer change. More women get breast cancer after turning 65, so screening mammogram each year are more important than ever at this age, and Medicare will usually cover it.
What is the cost of mammograms with Medicare?
If your doctor accepts it, Medicare Part B will cover the full cost of baseline and screening mammograms. Medicare mammogram coverage may vary in some cases. For example, diagnostic mammograms may only be partially covered by Part B, meaning you would have to pay 20 percent of the Medicare-approved amount. For more complete health care coverage, you may want to enroll in Medicare Advantage (Part C).
Aetna® Medicare Advantage plans can help cover mammogram costs
Want more mammogram coverage? An Aetna Medicare Advantage plan offers the same benefits you get with Original Medicare (Parts A and B), but with additional coverage for diagnostic mammograms. Exact costs may vary depending on the specific plan you choose.
Every woman over 35 should understand the importance of mammograms. And men should, too. According to the Centers for Disease Control and Prevention (CDC), 1 out of every 100 breast cancers diagnosed in the U.S. is found in a man.* Take the time to learn about the different kinds of Medicare coverage for mammograms.
Ready to explore your Medicare coverage options? Find an Aetna Medicare plan near you that may help cover mammogram services.
