After women reach the age of 40, yearly mammograms at minimum become extremely important. The medical world has found that screening mammograms once a year for women after the age of 40 greatly reduces the need for extreme surgeries and mortality in women because breast cancer can be detected very early.
Each year in the United States, about 240,000 cases of breast cancer are diagnosed in women. And in the UK is 55,900 which both are 0.14% and 0.17% of the female population respectively. But with the 5-year survival rate of localized (early stage) breast cancer being 99%, a Mammogram is vital to early diagnosis and treatment.
A mammogram is a type of medical imaging test that uses low-dose X-rays to examine the breasts. During a mammogram, the breasts are compressed between two plates to spread out the breast tissue and obtain clear images. These images can help identify any abnormal masses or calcifications in the breast that may require further evaluation.
While in the UK these are covered by the wonderful NHS, us older ladies in the USA have to rely on Medicare. So, the question becomes: what will Medicare pay for when it comes to mammograms? Medicare Part B, the main original part of Medicare, does cover mammograms, but if you have this insurance coverage, you will need to know the rules and coverage stipulations.
Three Types of Mammograms
First, you do need to know the three types of mammograms and how they are covered by Medicare. For women between the ages of 35 and 39, Medicare Part B will cover for one baseline mammogram. This is the very first mammogram a woman will have and it gives a base image of their breast tissue for future use. At times, it has detected very early breast cancer as well.
Medicare Part B will cover screening mammograms once per year for women over the age of 40. This is the regular preventative test to check for signs of cancer. If something is found, like a lump or odd and unusual tissue, then diagnostic mammograms may be needed. These are more in-depth and they may be needed more than once a year depending on the situation. Medicare Part B will cover diagnostic mammograms more than once a year if they are deemed medically necessary. However, there are some extra important rules to know about the diagnostic option.
If you have Medicare Part B coverage, then the baseline and screening mammograms will be covered 100% as long as there is only one baseline in a woman’s lifetime and only one screening every 12 months after the age of 40.
If a diagnostic mammogram is needed, then the following rules will apply: the provider must be Medicare approved, 80% of cost will be covered, and 20% up to the deductible will be the responsibility of the patient. Deductibles can change from year to year, so it is important you know your Medicare deductible before seeking this exam.
Those women who have Medicare part C may be able to get some assistance with the out of pocket cost for diagnostic mammograms. However, there are very specific rules to this and you will need to check with your Medicare provider before making an assumption about this coverage. You can learn more about Medicare part C on this page.
Things That Can Affect the Cost of a Mammogram or Other Service
Depending on your situation, there are also other things that can impact the cost of mammograms, if any. Knowing these details could save you hundreds of dollars. The first is secondary insurance. If you have any other insurance in addition to Medicare, they may cover any co-insurance or other out of pocket expenses.
To get a mammogram covered by Medicare Part B, it is vital that you go to a Medicare approved doctor who accepts assignment. If you go to a doctor who does not accept Medicare or who is not approved, then you could end up paying completely for the exam, even if it is for screening purposes.
If you need a diagnostic mammogram, since there are out of pocket costs, the fee the doctor charges, the type of the mammogram facility, and where you have the test done can all impact how much you end up paying. These are all important things to discuss with your doctor before you have any diagnostic mammograms done.
Whenever your doctor recommends a test or a treatment, it is vital to ask questions like the following: why is this test needed, what are you looking for with this test, will Medicare cover this test, will I need to pay anything out of pocket? It is best to know in advance what to expect instead of receiving a very high medical bill that you were not expecting.
Over the years, as scientific discoveries and medicine have advanced, we have created diagnostic tools that can greatly reduce serious impacts of some of the scariest and worst medical conditions. When it comes to breast cancer, it has been proven that mammograms can detect the cancer early and can change the prognosis of breast cancer for many patients.
Doctors do recommend regular mammograms for women over the age of 40. Medicare Part B does cover yearly mammograms (and a baseline one for women under 40) in full. There can be costs, as mentioned above, for mammograms needed more often if something of concern is seen in the screening process. Know what is covered and what your cost may be so that you are prepared when you need the screens instead of being surprised by out of pocket expenses you were not prepared for and may not be able to afford.