Medicare Mammogram Coverage After Age 65: What You Need to Know

Turning 65 is a significant milestone that often comes with a shift to Medicare for your health insurance. For many women, this transition raises important questions about preventive care, especially for critical screenings like mammograms. You might be wondering if your new coverage will continue to support your breast health in your later years. The good news is that Medicare recognizes the vital importance of early detection and provides robust coverage for mammograms for beneficiaries well beyond age 65. Understanding the specifics of this coverage, including how often you can get screened and what your costs will be, is essential for maintaining your health and financial well-being. This guide will walk you through everything you need to know about Medicare and mammograms after 65, ensuring you can confidently access this life-saving service.

Understanding Medicare’s Coverage for Mammograms

Medicare Part B, which covers outpatient services and preventive care, is the part of Medicare that pays for screening mammograms. This coverage is not a one-time benefit but a continuous part of your preventive care plan for as long as you are enrolled in Medicare. The program adheres to guidelines that emphasize regular screening for early detection of breast cancer, a disease where risk increases with age. Coverage is available for all female beneficiaries aged 40 and older, meaning it seamlessly continues after you turn 65. It is important to distinguish between a screening mammogram, which is a routine check for women with no signs or symptoms of breast disease, and a diagnostic mammogram, which is used to investigate a specific concern, such as a lump or an abnormal finding from a screening. Medicare covers both, but the rules and cost-sharing can differ.

Frequency, Costs, and Eligibility Details

Medicare sets clear guidelines on how often you can receive a screening mammogram at little to no cost. For beneficiaries aged 40 and older, Medicare Part B covers one screening mammogram every 12 months. There is no upper age limit for this benefit, so women aged 65, 75, 85, and beyond are all eligible for annual screenings. For women between the ages of 35 and 39, Medicare covers one baseline screening mammogram. The standard cost structure is highly favorable for preventive care. For a screening mammogram, you pay $0 for the test itself if your doctor accepts Medicare assignment. This means the provider agrees to the Medicare-approved amount as full payment. You also pay nothing for the Part B deductible. However, you may have to pay a copayment for the facility fee if the test is performed in a hospital outpatient setting. Diagnostic mammograms follow different rules. If you need a diagnostic mammogram, you typically pay 20% of the Medicare-approved amount for the radiologist’s services, and the Part B deductible applies. The facility fee for a hospital outpatient setting also applies.

To ensure you face no surprise bills, it is critical to use healthcare providers and facilities that participate in Medicare and accept assignment. You are not required to get a referral from your primary care doctor for a screening mammogram, which simplifies the process. For a deeper understanding of how Medicare handles cost-sharing for other procedures, you can review our analysis on does Medicare pay for tooth extractions, which outlines similar coverage structures.

Medicare Advantage Plans and Additional Coverage

Many seniors choose to get their Medicare benefits through a Medicare Advantage (Part C) plan offered by private insurance companies. These plans are required to cover everything that Original Medicare (Parts A and B) covers, including mammograms. In fact, many Advantage plans offer $0-cost screening mammograms as part of their preventive care benefits, often with no facility copay, making them even more cost-effective. However, the rules can vary. Some plans may require you to use in-network providers or facilities to get the full $0 benefit. It is imperative to check your plan’s Evidence of Coverage (EOC) document or call your plan directly to confirm the specifics. Many Advantage plans also offer extra benefits that Original Medicare does not cover, such as dental, vision, and wellness programs. To explore how supplemental plans can enhance your core coverage, consider reading about how to boost your Medicare coverage with Farm Bureau health plans.

Why Regular Screenings Remain Crucial After 65

The risk of developing breast cancer increases with age. According to the American Cancer Society, about two-thirds of invasive breast cancers are found in women aged 55 or older. This makes consistent screening after 65 not just a covered benefit, but a critical component of long-term health maintenance. Early detection through mammography can find cancers when they are small, localized, and most treatable, significantly improving survival rates. Despite this, some women may stop getting mammograms due to misconceptions about age, concerns about cost, or simply because they are no longer reminded by an obstetrician/gynecologist. It is important to discuss your personal screening schedule with your doctor, as individual risk factors, such as family history or genetic predispositions, may warrant more frequent monitoring. Maintaining your overall wellness involves both physical screenings and managing mental health; for a creative approach to the latter, learn about art therapy and Medicare coverage options.

Steps to Schedule Your Medicare-Covered Mammogram

Scheduling your mammogram is a straightforward process. First, find a facility that accepts Medicare. Most imaging centers, hospitals, and mobile mammography units do. You can use the Medicare.gov “Physician Compare” tool or call 1-800-MEDICARE for assistance. When you call to make an appointment, inform the scheduler that you have Medicare. They will typically handle the billing directly with Medicare. It is a good practice to confirm with the facility that they accept Medicare assignment. When you go for your appointment, bring your Medicare card. If you have a Medicare Advantage plan, bring that plan’s card instead. The facility will bill Medicare or your Advantage plan directly. You should receive a Medicare Summary Notice (MSN) or an Explanation of Benefits (EOB) from your Advantage plan showing the service and what was paid. Keep this for your records. Just as it’s important to understand your coverage for medical services, knowing how to access your benefits seamlessly is key. For tips on managing your insurance tools, see our resource on the Blue Medicare card and its uses.

Frequently Asked Questions

Q: Does Medicare cover 3D mammograms (tomosynthesis)?
A: Yes, Medicare Part B covers 3D mammograms when performed in conjunction with a standard 2D digital screening mammogram. However, there may be an additional cost for the 3D component, as it might not be fully covered under the preventive screening benefit. You could be responsible for a copayment. Always check with your provider and your plan about costs before the procedure.

Q: I have Medicare and a Medigap plan. How does that affect my mammogram cost?
A: If you have a Medigap (Medicare Supplement) plan, it can help cover the out-of-pocket costs that Original Medicare does not pay. For a screening mammogram with no facility copay, you likely will owe nothing, and Medigap would not need to pay. For a diagnostic mammogram where you owe 20% coinsurance, your Medigap plan (depending on its letter) would typically cover that 20%, potentially leaving you with $0 out-of-pocket.

Q: Are mammogram recalls covered by Medicare?
A: Yes, if your screening mammogram shows something that requires additional imaging, such as a diagnostic mammogram or an ultrasound, Medicare will cover those follow-up tests. They will be billed as diagnostic services, so the 20% coinsurance and deductible rules will apply.

Q: Does Medicare cover genetic testing for breast cancer, like BRCA testing?
A: Medicare Part B may cover genetic counseling and BRCA testing for women who meet specific criteria indicating a high risk for hereditary breast cancer. This is not a routine screening and requires a doctor’s order based on personal and family history.

Navigating Medicare coverage for essential services like mammograms empowers you to take charge of your health without financial worry. The system is designed to support your well-being through every stage of life, and utilizing your preventive benefits is one of the smartest ways to use your coverage. By scheduling your annual mammogram, confirming your costs in advance, and staying in communication with your healthcare provider, you can ensure that breast cancer screening remains a consistent and accessible part of your healthcare routine for years to come.