Does Medicare cover 3D mammogram?

Medicare covers a 3D mammogram under your Part B coverage at no additional cost. For a diagnostic 3D mammogram, your coinsurance with Original Medicare is 20%, and you will have to pay your Part B deductible. If you have a Medicare Advantage plan or a Medicare Supplement plan, you may have additional Medicare coverage for a 3D mammogram that pays out-of-pocket expenses.

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UPDATED: Feb 21, 2022

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The Highlights

  • Medicare covers a baseline mammogram for women 35-39 and annual screening mammograms for women 40+ at no charge
  • Medicare will also cover a diagnostic mammogram if medically necessary with a coinsurance amount
  • You can have a 3d mammogram at no additional cost under your Original Medicare plan

Does Medicare cover a 3D mammogram? While not all health insurance plans will pay for a 3D mammogram, if you have Medicare it is covered at no additional cost. There are a deductible and coinsurance amount for diagnostic mammograms, but that may be covered by a Medicare Supplement plan. Medicare Advantage plans may also cover it without out-of-pocket expenses depending on your plan.

If you’d like to compare quotes for Medicare options that cover 3D mammograms without out-of-pocket expenses, enter your ZIP code above.

Does Medicare cover a 3D mammogram?

According to Medicare.gov, Medicare will cover mammograms under your Part B coverage.  This includes 3D mammograms, also known as digital breast tomosynthesis (TOMO),  at no additional charge. Medicare covers the following different types of mammograms:

  • One baseline mammogram for women between the ages of 35-39
  • One screening mammogram every 12 months for women 40 and over
  • Diagnostic mammograms more often when medically necessary

Whether a diagnostic mammogram is medically necessary will be decided by your doctor. Since the other types are considered to be preventative care, they are covered automatically.

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Does Medicare cover mammograms after age 65?

Medicare does cover mammograms for women aged 65-69. Annual screening mammograms have 100% coverage. Medicare pays 80% of the cost of diagnostic mammograms. Mammograms remain an important cancer detection tool as you age.

How often is a mammogram covered under Medicare?

Medicare will cover a mammogram every year for women aged 40 and older. Medicare covers screening mammograms and diagnostic mammograms slightly differently, so it helps to know how your coverage works before going to your doctor.

What is the out-of-pocket cost of a 3D mammogram?

For a screening mammogram, there is no out-of-pocket cost under Original Medicare Part B. The coinsurance amount for a diagnostic mammogram is 20 percent of the Medicare-approved amount. You will also have to pay your Part D deductible or any part of it that is remaining unless you have already met it for the year.

There is no increased cost for a 3D mammogram over a 2D mammogram with Original Medicare

If you have Medicare Advantage, the coinsurance and deductible amounts will vary by plan. You’ll need to look at your summary of benefits or contact the insurance company that handles your Medicare Advantage plan to find out what you can expect to pay. Medicare Supplement Insurance (Medigap) can also help to pay deductibles and coinsurance amounts for Original Medicare, which can reduce the out-of-pocket cost of a 3d mammogram to $0 in some cases.

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Does Medicare cover a 3D mammogram? The Bottom Line

Medicare does cover 3D mammograms with no additional cost to you beyond coinsurance and deductible amounts that may apply to a diagnostic mammogram. Whether you have a 2D or 3D mammogram will not affect the coverage provided by Medicare.

Risk factors for breast cancer include but are not limited to: a family history of breast cancer, genetic predispositions, personal history with breast cancer, breast density, obesity, drinking alcohol, early menstruation, delayed childbearing and having fewer children.

Most major health organizations do recommend that you continue to have regular mammograms as long as you are in good health.

You may be able to reduce your out-of-pocket costs for a 3D mammogram by choosing Medicare Advantage or adding a Medicare Supplement plan to your Original Medicare. To compare rates for these Medicare options, enter your ZIP code now.

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