Is a 3D mammogram covered by Medicare?

Experts recommend that all women ages 50 to 74 have breast cancer screenings every two years. Both 2D and 3D mammograms can be effective at identifying early signs of the disease, which can lead to a better treatment plan and an improved overall outcome for cancer patients. 

Some people with certain family or medical histories with an increased risk for breast cancer may need to get a mammogram even sooner. They may also need them more often. 

The good news is that 2D and 3D mammograms are covered by Medicare.

This guide discusses when mammograms are covered by Medicare, but you should talk with your doctor to find out which schedule is right for you. Once you know which type of mammogram you need and how often you’ll need it, you can determine exactly what to expect with your Medicare coverage.

Does Medicare cover 2D and 3D mammograms?

Traditional 2D mammograms take images of breast tissue from the sides and front to create an overlapping image. 3D mammograms use images from multiple angles for a clearer, more detailed final image. 

While both are considered effective, 3D mammograms can be more precise and accurate. And if it sounds like a 3D mammogram may be more expensive, you’re right. 

Fortunately, if you have Medicare and your doctor recommends a 3D mammogram, you won’t have to worry — Medicare covers 2D and 3D mammograms the same.

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Which 3D mammograms are covered by Medicare?

While 3D mammograms are covered by Medicare, some scenarios could leave you with some out-of-pocket costs. It’s important that you understand the different classifications of mammograms so you can accurately budget your healthcare costs.

Baseline Mammograms

Your very first mammogram screening is referred to as your baseline. This can be 2D or 3D. 

For women with no known cancer risks or family history of breast cancer, this may not be recommended until you reach the age of 50. However, you may have a higher risk for breast cancer if you:

• Have dense breast tissue
• Have a family history of breast or ovarian cancer
• Have a personal history of breast disease or cancer

In these situations, your doctor may recommend that you schedule a baseline mammogram as early as 35. Medicare will cover one baseline mammogram for members between the ages of 35 and 39.

Screening Mammograms

A screening mammogram is used on an annual basis to monitor breast tissue for any potential changes. Screening mammograms are the most common type and are completely covered by Medicare for people ages 40 and older, as long as they are at least one full calendar year apart.

You may not need a mammogram once a year. Some doctors recommend one every two years. Regardless of the schedule you and your doctor decide on, Medicare will cover the costs entirely as long as it has been at least one full year since your last mammogram.

Diagnostic Mammograms

A doctor often recommends a diagnostic mammogram if you develop any signs or symptoms that require further testing. This could be for a variety of reasons, including:

• Chronic breast pain or tenderness
• The development of a lump or mass
• Changes in breast size or shape
• Abnormalities found on a screening mammogram

A diagnostic mammogram is part of your doctor’s plan to diagnose and treat a medical condition, separating this type of mammogram from the others. In this situation, you should be prepared to pay for part of the cost on your own.

How much do mammograms cost?

If you need a diagnostic mammogram and you have Medicare, your Part B plan will cover 80% of the Medicare-approved amount. After you meet your annual deductible, you will have to pay the other 20%. 

Keep in mind that if the cost of the 3D mammogram is higher than the Medicare-approved amount, you’ll also be responsible for the difference. For example, let’s assume you’ve met your deductible for the year, which is $233 for 2022. 

You could schedule a diagnostic mammogram at a facility that charges $120 for a 3D mammogram, but your Medicare plan may only approve a maximum amount of $100. 

Medicare Part B will cover 80% of this approved amount, which is $80. You would be responsible for the other 20%, which is $20. However, you would also have to pay the extra $20 that was over the Medicare-approved amount. So in this scenario, your total out-of-pocket costs would be $40.

Remember, the costs will vary based on where you live and which office you choose. You can check the official government website for up-to-date Medicare costs.

How To Limit Out-of-Pocket Costs for 3D Mammograms

If your doctor recommends a 3D mammogram, choose a facility that accepts Medicare plans. You can also contact the office before the appointment to find out your total costs and what your Medicare plan will cover.

Some people choose to sign up for Medicare Advantage plans or add supplemental insurance to Medicare to help with out-of-pocket expenses. If you have one of these plans, contact the company to find out exactly what’s covered.

3D Mammograms and Medicare: The Essential Facts

3D mammograms are one of the most reliable and accurate ways to detect breast cancer and other diseases. Medicare will cover the entire cost for baseline and yearly mammograms, assuming you fall within the approved age range. 

Most people can expect to pay 20% of the cost of a medically-necessary diagnostic mammogram after meeting their Medicare B deductible. If you’re looking for help paying for out-of-pocket medical expenses, you may want to consider a Medicare supplement plan.

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