Quick Answer
Medicare Part B covers annual screening mammograms for women age 40 and older at no cost (100% covered as a preventive service). Diagnostic mammograms are covered at 80%, with the beneficiary responsible for 20% coinsurance after the Part B deductible. Medicare also covers 3D mammograms and breast ultrasounds when medically necessary.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Original Medicare Part B | Covered (Screening: $0 / Diagnostic: 20%) | Annual screening mammogram at no cost; diagnostic mammogram with 20% coinsurance |
| Medicare Advantage (Part C) | Covered | Must cover all Original Medicare benefits; many plans offer $0 cost for both types |
| Medicare Supplement (Medigap) | Covers Your 20% | Medigap plans cover the 20% coinsurance for diagnostic mammograms |
| Medicare Part D | Not Applicable | Part D covers prescription drugs, not diagnostic imaging |
Understanding Your Coverage Options
Original Medicare Part B
Medicare Part B covers screening mammograms as a preventive service for women age 40 and older - once every 12 months at no cost to you (no deductible, no coinsurance) when your provider accepts Medicare Assignment. For women under 65 enrolled in Medicare, Part B also covers one baseline mammogram between ages 35 and 39.
Diagnostic mammograms are covered when ordered by a healthcare provider as medically necessary - for example, when a lump is detected or other symptoms are present. For diagnostic mammograms, you pay 20% of the Medicare-approved amount after meeting your Part B deductible. If your screening mammogram detects an abnormality, it is automatically reclassified and billed as a diagnostic mammogram.
Medicare Advantage (Part C)
Medicare Advantage plans must cover all Original Medicare benefits, including mammograms. Many Medicare Advantage plans cover both screening and diagnostic mammograms at $0 cost to you, with no deductible or coinsurance. Check your plan's Summary of Benefits for specific cost-sharing details.
Medicare Supplement (Medigap)
If you have a Medicare Supplement (Medigap) plan, it will cover your 20% coinsurance for diagnostic mammograms after Medicare pays its 80% share. For screening mammograms, there is no cost-sharing to supplement since Medicare covers them at 100%.
Comprehensive Medigap plans like Plan G cover the Part B coinsurance, meaning your diagnostic mammogram would be covered at no additional cost to you after Medicare pays.
Mammogram Costs under Medicare
| Mammogram Type | Medicare Covers | Your Cost (No Supplement) | Your Cost (With Plan G) |
|---|---|---|---|
| Annual Screening Mammogram (2D) | 100% | $0 | $0 |
| Annual Screening Mammogram (3D/Tomosynthesis) | 100% | $0 | $0 |
| Diagnostic Mammogram | 80% after deductible | ~$34–$50 (20%) | $0 |
| Breast Ultrasound (medically necessary) | 80% after deductible | 20% of approved amount | $0 |
| Breast MRI (medically necessary) | 80% after deductible | 20% of approved amount | $0 |
✦ Special Mammogram Coverage Rules
Baseline Mammogram (Ages 35–39)
Medicare covers one baseline screening mammogram for women between ages 35 and 39 who are enrolled in Medicare. This is a one-time benefit.
Annual Screening (Age 40+)
Once you turn 40, Medicare covers one screening mammogram every 12 months at no cost. There is no upper age limit - Medicare covers annual mammograms for women in their 70s, 80s, 90s, and beyond.
Screening Reclassified as Diagnostic
If your screening mammogram detects an abnormality (such as a lump), it is automatically reclassified and billed as a diagnostic mammogram. This means you will be responsible for 20% coinsurance, even though the visit started as a routine screening.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent dedicated to helping those eligible for Medicare find the best coverage options.