Getting a proper screening for breast cancer requires knowing your options for coverage. Here is a guide on coverage of Medicare for mammograms.
Did you know that the two biggest risk factors for breast cancer are being female and getting older? Experts have recommended mammograms for decades to facilitate the early detection of breast cancers.
Do you ever worry about coverage by Medicare for mammograms? Keep reading to learn more about mammograms and how Medicare pays for them.
Purpose of Mammograms
A mammogram screening is an X-ray of the breast using low-dose X-rays. The goal is to detect breast cancer before a person has any symptoms. Breast cancer that’s detected early is often the most treatable.
How Mammograms Work
The breast is briefly compressed twice between two plates. The machine makes a radiologic image from two different views. One is from the top-down and the other is on an angle from the center of the chest to the side.
The radiologist examines the image for abnormal areas. If they find anything suspicious, further testing will take place.
Medicare for mammograms
Medicare Part B beneficiaries without symptoms or a history of breast cancer have coverage. Women 35 to 39 years may have one baseline mammogram. Women over the age of 39 may have one screening mammogram each year.
It’s important to note that Medicare doesn’t cover screening mammograms for men. They will cover diagnostic mammograms for women and men. Providers order this type of mammogram when someone has an identified abnormality.
Cost of Mammograms
Screening mammograms have 100% coverage for members who qualify for Part A and B. You must use a Medicare-approved provider. This is also true for Medicare Advantage Plans if Medicare requirements are met.
If you have a diagnostic mammogram, 80% of the Medicare-approved cost is covered. You will need to pay the 20% coinsurance after meeting your Plan B deductible. Your Medicare Advantage Plan’s cost-sharing may apply with in-network providers.
Cost of Medicare
Medicare coverage involves many different Medicare plans and supplements. The following provides a brief overview of common plans and only their premiums for 2021.
Medicare Part A
Medicare Part A covers inpatient hospitalization without monthly premiums for most people. If you paid into Medicare for 7.5 to 10 years, then your cost will be $263/month. Those who paid into Medicare for less than 7.5 years will pay $478/month.
Medicare Part B
Part B covers many outpatient services. Most beneficiaries will pay $153.30/month. This premium depends on the Social Security cost of living adjustment for 2021.
Medigap Plan G will cost about $140/month. Yet, rates vary depending on location, use of tobacco products, gender, and age.
Medicare Advantage Part C requires that you pay the Part B premium. You must then also pay the Medicare Advantage monthly premium which is about $36/month. This type of plan includes Part D.
Medicare Part D coverage which pays for prescription medications. The premium will be about $30.50/month. Enhanced plans and those in some states cost more.
Do You Have Questions About Medicare?
This article answered the question about the coverage by Medicare for mammograms. If you have other questions about Medicare, you’ve come to the right place.
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