Does Medicare Cover Mammograms After Age 70?

For millions of American seniors, Medicare is the cornerstone of their healthcare coverage. As we age, the importance of preventive screenings like mammograms only increases, yet confusion often arises about coverage limits, especially after a certain age. A common and critical question is whether Medicare continues to pay for mammograms after 70. The short answer is a resounding yes, but understanding the specifics, frequency, and potential costs is essential for maximizing your benefits and maintaining your health. This guide provides a comprehensive look at Medicare’s mammogram coverage for beneficiaries over 70, helping you navigate the rules to ensure you receive the preventive care you need.

Medicare’s Stance on Mammograms for Seniors

Medicare Part B, which covers outpatient services and preventive care, provides coverage for screening mammograms. Importantly, there is no upper age limit for this benefit. The Centers for Medicare & Medicaid Services (CMS) explicitly states that coverage continues for as long as a woman is eligible for Medicare. This policy is grounded in medical evidence that shows breast cancer risk continues to rise with age. The average age of a breast cancer diagnosis in the United States is 62, and nearly 30% of new cases are diagnosed in women aged 70-84. Discontinuing screenings at an arbitrary age could miss detecting cancers in this high-risk population. Therefore, Medicare aligns with guidelines from organizations like the American Cancer Society, which recommend continuing screening mammography as long as a woman is in good health and has a life expectancy of 10 years or more.

Coverage Details, Frequency, and Costs

Medicare Part B covers 100% of the Medicare-approved amount for a screening mammogram every 12 months (once per calendar year). This means you pay $0 for the test itself if your doctor accepts Medicare assignment. It is crucial to distinguish between a “screening” mammogram, which is a routine check for women with no signs or symptoms of breast cancer, and a “diagnostic” mammogram, which is used to investigate a specific concern like a lump or pain. Diagnostic mammograms are also covered by Medicare Part B, but different cost-sharing rules apply. For diagnostic exams, you typically pay 20% of the Medicare-approved amount after meeting your Part B deductible. Understanding this distinction is key to anticipating potential out-of-pocket expenses.

Here is a breakdown of Medicare’s mammogram coverage structure for beneficiaries over 70:

• Screening Mammogram: Covered once every 12 months at no cost (you pay $0) if the provider accepts assignment.
• Diagnostic Mammogram: Covered as medically necessary; you pay 20% of the Medicare-approved amount after the Part B deductible.
• Additional Screening: Women at high risk (e.g., family history, genetic predisposition) may qualify for coverage of a 3D mammogram (tomosynthesis) or more frequent screenings, though cost-sharing may apply.
• Facility Type: Coverage applies whether the test is done in a hospital outpatient department, a dedicated imaging center, or a mobile screening unit.

It is advisable to confirm with your provider that they accept Medicare assignment before your appointment to ensure the $0 cost for a screening. For more on how Medicare costs can change, you can review our detailed analysis on whether Medicare costs go up every year.

Medicare Advantage and Supplemental Coverage

If you are enrolled in a Medicare Advantage (Part C) plan, your mammogram coverage is at least as good as Original Medicare (Parts A and B). By law, all Medicare Advantage plans must cover all the same preventive services that Original Medicare covers, without applying cost-sharing. Many plans may offer additional benefits, such as lower or $0 copays for diagnostic tests or coverage for advanced screening technologies. However, you must use providers within your plan’s network to receive the highest level of coverage. Always check your plan’s Evidence of Coverage document or call your insurer for specifics.

For those with Original Medicare, a Medigap (Medicare Supplement) policy can help cover the out-of-pocket costs associated with diagnostic mammograms. For example, if you have a diagnostic mammogram and owe the 20% coinsurance, your Medigap plan may cover some or all of that cost, depending on your plan letter (e.g., Plan G or Plan N). This supplemental coverage can provide significant financial peace of mind. To explore other covered services, you might be interested in learning about Medicare coverage for Ozempic for related health conditions.

Why Continued Screening After 70 Matters

The decision to continue regular mammograms should be a personalized one, made in consultation with your doctor based on your overall health, life expectancy, and personal risk factors. However, the statistical rationale for ongoing screening is strong. Breast tissue density often decreases with age, which can actually make mammograms easier to read and potentially more accurate in detecting abnormalities. Furthermore, early detection in older adults can lead to less aggressive treatment options and better outcomes. Age alone should not be a barrier to receiving evidence-based preventive care. Open communication with your healthcare provider is essential to develop a screening schedule that is right for your individual health profile.

Navigating the Process and Avoiding Surprises

To ensure smooth coverage and avoid unexpected bills, follow these steps. First, when scheduling your mammogram, clearly state that you are scheduling a “screening mammogram” as part of your Medicare preventive benefit. Verify that the facility and radiologist accept Medicare assignment. When you arrive for your appointment, double-check that the order from your doctor is coded correctly for a screening, not a diagnostic exam, unless you have a specific symptom. Keep records of your test dates to ensure you are scheduling them at least 12 months apart to maintain the annual coverage cycle. If you receive a bill you believe is in error, contact the provider’s billing office and your Medicare plan. For comprehensive guidance on your benefits, our essential facts on Medicare and mammograms provide further detail.

Frequently Asked Questions

Q: Does Medicare cover 3D mammograms (tomosynthesis) for women over 70?
A: Medicare Part B covers 3D mammograms as part of a screening mammogram, but only for women who are at high risk for breast cancer or who have dense breast tissue. If you are not in a high-risk category, you may have to pay an additional fee for the 3D portion, as it may not be fully covered. Check with your provider and your plan beforehand.

Q: I found a lump. Will Medicare cover a mammogram even if I had one recently?
A: Yes. If you have a symptom or concern, your doctor will order a diagnostic mammogram. Medicare covers diagnostic mammograms without regard to the 12-month screening rule, as they are considered medically necessary. The standard 20% coinsurance under Part B would apply.

Q: Are there other breast cancer screening tests covered by Medicare?
A: Medicare Part B covers a clinical breast exam as part of the Annual Wellness Visit, but it does not routinely cover other screening methods like breast MRI or ultrasound for average-risk women. These may be covered if you are high-risk or if a potential abnormality is found on a mammogram.

Q: How does Medicare coverage for mammograms compare to hearing aid benefits?
A: Medicare’s coverage for preventive screenings like mammograms is generally robust with $0 cost-sharing. In contrast, Original Medicare does not cover routine hearing aids or exams, though some Medicare Advantage plans may offer benefits. You can learn more about options in our resource on Medicare and hearing aids.

Staying informed about your Medicare benefits is a powerful tool for managing your long-term health. By understanding that Medicare does pay for mammograms after age 70, you can confidently schedule this vital preventive service. Proactive screening, combined with regular discussions with your physician, remains one of the most effective strategies for early detection and successful management of breast health well into your senior years. Take charge of your preventive care schedule today.