Does Medicare Cover 3D Mammograms?
Breast cancer screening is a crucial part of preventive healthcare, and many beneficiaries wonder: Will Medicare cover a 3D mammogram? The good news is that Medicare does cover 3D mammography, also known as digital breast tomosynthesis (DBT), under certain conditions.
Medicare Coverage for 3D Mammography
Medicare Part B covers screening mammograms once every 12 months for eligible women aged 40 and older. This coverage includes both traditional 2D and advanced 3D mammograms, provided the procedure is performed at a Medicare-approved facility.
Additionally, Medicare fully covers the cost of screening mammograms as part of its preventive care benefits, meaning there is no out-of-pocket expense if the mammogram is categorized as a screening test and meets Medicare’s criteria.
However, if the mammogram is considered diagnostic (performed due to symptoms, abnormalities, or a follow-up to a previous screening), then Medicare Part B covers 80% of the cost after the beneficiary meets the annual Part B deductible. The remaining 20% is typically paid out-of-pocket or covered by a Medicare Supplement (Medigap) plan.
Are 3D Mammograms Covered for High-Risk Individuals?
Yes, Medicare also covers additional screening mammograms for high-risk individuals, such as those with a family history of breast cancer or genetic predisposition. Women under 40 with risk factors may qualify for Medicare-covered mammograms if deemed medically necessary by a healthcare provider.
How Much Does a 3D Mammogram Cost Out of Pocket?
The cost of a 3D mammogram without insurance can range from $150 to $300 or more, depending on the facility, location, and type of service. If Medicare does not fully cover the mammogram (for example, if it is considered a diagnostic rather than a screening test), beneficiaries may have to pay 20% of the Medicare-approved amount, which can be around $30 to $60 after the deductible is met.
Does Medicare Pay for Digital Breast Tomosynthesis?
Yes, Medicare pays for digital breast tomosynthesis (DBT) as part of its annual screening mammogram benefit. Since 3D mammography is now widely recognized as a more effective screening tool, Medicare has expanded its coverage to include both 2D and 3D mammograms at no cost to beneficiaries under preventive care guidelines.
For diagnostic mammograms, Medicare covers a portion of the cost, with the patient responsible for the remaining balance unless they have additional coverage through a Medigap or Medicare Advantage (Part C) plan.
Conclusion
Medicare provides comprehensive coverage for 3D mammograms, ensuring that beneficiaries have access to advanced breast cancer screening without additional financial burden. To maximize your Medicare benefits, confirm that your healthcare provider accepts Medicare, and always verify whether the mammogram is categorized as a screening or diagnostic test before the procedure.
Need More Information?
If you have questions about Medicare coverage for mammograms or need assistance choosing the best Medicare plan, contact a licensed Medicare advisor for personalized guidance.
