Does Medicare cover ultrasound for dense breast tissue?

Medicare will cover breast ultrasound for diagnostic purposes when it is medically necessary. For example, if you require annual mammograms due to a history of breast cancer in your family. For breast cancer screening purposes, only mammograms are covered by Medicare in full.

If your doctor determines that a breast ultrasound is required due to dense breast tissue or for any other medically necessary reason, you will pay the Part B deductible as well as 20 percent coinsurance. Medicare Supplement insurance can cover all or part of this out-of-pocket amount. 

While many women now receive no-cost coverage for mammography services, women who get diagnostic mammograms, those who get preventive services out-of-network, or who are in grand-fathered plans may be subject to co-payments, cost-sharing, or deductibles.

You may also want to consider a Medicare Advantage health insurance plan, which often includes additional coverage not available with original Medicare.

If you would like to shop for a Medicare plan to cover breast ultrasound for dense breast tissue, enter your ZIP code now. Taking time to comparison shop can lead you to a medical provider who will be able to give you quality service at affordable prices.

What coverage is included with Medicare geared towards dense breast tissue?

If your doctor determines that further testing is required after a regularly scheduled screening mammogram or a diagnostic mammogram, you may be eligible for a breast ultrasound. This is usually done when dense breast tissue makes it difficult to view cancerous masses on standard mammography.

A screening mammogram is covered for all women on Medicare at regular intervals and is covered as preventative care. A breast ultrasound is typically treated not as preventative but as a diagnostic tool and is treated that way under your coverage.

A regular screening mammogram is just one preventive health care service for women that Medicare covers.

Because Medicare Advantage plans are run by private health insurance companies, they can offer some slightly different coverage. Check with your plan provider to see what is covered.

What is the cost of breast ultrasound for dense breast tissue with Medicare?

Breast ultrasound is covered when necessary under Medicare Part B. That means it’s subject to the Part B deductible as well as coinsurance. After your deductible is met, Medicare will cover 80% of the cost. If you have Medicare Supplement insurance it will pay for all or part of the deductible and 20% health care coinsurance cost, depending on the plan you have.

Your cost with a Medicare Advantage plan will differ depending on your coverage details. Each Medicare Advantage plan has its own deductibles and coinsurance amounts. Check with your plan provider to find out how much it will cost you.

Does Medicare cover mammograms after age 65?

Getting a mammogram can sometimes be medically necessary after a certain age, or even beforehand if breast cancer runs in a person’s family. Medicare does cover mammograms for women aged 65-69. Annual screening mammograms have 100% coverage. Medicare pays 80% of the cost of diagnostic mammograms. Getting a mammogram is an important cancer detection tool as you age.

Does Medicare cover 3D breast imaging?

In addition to 3D mammograms, Medicare covers 3D breast MRIs if necessary. You can expect to pay 20% of the cost of an MRI if you don’t have supplemental insurance. (For more information, read our “Does Medicare cover 3D mammograms?“).

Since Medicare covers these medical procedures only if they’re necessary, you will want to talk to your doctor first before scheduling an appointment.

Case Studies: Medicare Coverage for Ultrasound in Dense Breast Tissue

Case Study 1: Maria’s Diagnostic Ultrasound

Maria, a 55-year-old woman, recently had a mammogram that revealed dense breast tissue. Her doctor recommended a diagnostic ultrasound to further evaluate her breast health. As Medicare covers ultrasound for dense breast tissue as a diagnostic tool, Maria’s ultrasound was deemed medically necessary.

She had to pay the Part B deductible and 20% coinsurance for the procedure. Maria discovered that her Medicare Supplement insurance covered these out-of-pocket costs.

Case Study 2: Laura’s Preventive Mammogram

Laura, a 68-year-old woman, scheduled her regular preventive mammogram covered by Medicare. During the mammogram, dense breast tissue was observed, warranting a follow-up ultrasound. However, Medicare only covers mammograms as screening tools, not ultrasound for breast tissue evaluation.

Laura needed to pay for the ultrasound out of pocket. She considered switching to a Medicare Advantage plan that might offer additional coverage for breast ultrasound.

Case Study 3: Sarah’s Medicare Advantage Coverage

Sarah, a 62-year-old woman, opted for a Medicare Advantage plan instead of the original Medicare. Her plan provided coverage for breast ultrasound as a diagnostic tool, including cases of dense breast tissue.

The cost of the ultrasound varied based on her plan’s deductibles and coinsurance. Sarah found it helpful to review the coverage details of her Medicare Advantage plan to understand her out-of-pocket expenses accurately.

The Bottom Line: Does Medicare pay for breast ultrasound?

Medicare covers ultrasound for dense breast tissue when it is determined to be medically necessary. It will be covered under Medicare Part B and subject to a deductible and coinsurance. You can get some or all of those costs covered with a Medicare Supplement plan. Meaning there would be no out-of-pocket costs.

If you have several high-risk factors, such as a family history of breast cancer or a history of precancerous breast lesions, your doctor may also recommend a magnetic resonance imaging, or MRI, in addition to your mammogram. If a breast cancer diagnosis is found sooner rather than later, it could lead to better chances of recovery.

Many women with an average risk of breast cancer often start getting mammograms around age 40. Since it’s a service that is generally covered, especially for those at risk for breast cancer, it may be good to look into an annual screening mammogram, which is where someone goes once a year.

Shopping around for coverage can lead you to more affordable insurance that includes breast cancer screening tests. To compare your options for a Medicare plan that covers breast ultrasound for dense breast tissue, enter your ZIP code now.