Does Medicare Cover Mammograms? (2026)

Direct Answer: What Medicare Covers for Mammograms (2026)

Yes, Medicare covers mammograms. Screening mammograms for women aged 40 and older are covered at no cost under Medicare Part B as a preventive benefit. One screening mammogram per year costs $0. Diagnostic mammograms ordered for a symptom, lump, or prior abnormal result are covered but trigger the 2026 Part B deductible of $283 plus 20% coinsurance. 3D digital breast tomosynthesis is covered at the same rate as 2D when a physician determines it is medically appropriate.

Screening Mammograms: What Original Medicare Covers

Original Medicare Part B covers one screening mammogram per year for women who are 40 or older with no deductible and no coinsurance. Women between 35 and 39 may receive one baseline mammogram covered at the preventive rate as well. The ACA Section 2713 requires Medicare to cover preventive services rated A or B by the U.S. Preventive Services Task Force (USPSTF) with no cost sharing. The USPSTF gives mammography a B rating for women aged 40 to 74, which is why the screening is free under Part B. Medicare does not separately set an age cutoff at 50; coverage at age 40 reflects the 2024 USPSTF guidance update that lowered the recommended starting age from 50 to 40.

Coverage is available at any Medicare-certified mammography facility nationwide. To find a certified facility near you, use the FDA Mammography Quality Standards Act (MQSA) facility database at fda.gov or the Medicare.gov physician/facility finder. The facility must accept Medicare assignment for the $0 cost-sharing to apply. If the facility does not accept Medicare assignment, you may owe a portion of the Medicare-approved amount.

Diagnostic Mammograms: Cost-Sharing Rules in 2026

Diagnostic mammograms are ordered when there is a clinical reason to investigate: a palpable lump, breast pain, nipple discharge, or a prior abnormal screening result. Medicare Part B covers diagnostic mammograms, but they are NOT treated as preventive services, so the standard Part B cost-sharing applies. In 2026 that means: you pay the $283 Part B annual deductible first (if not already met), then 20% coinsurance on the Medicare-approved amount. The radiologist or facility bills 80% to Medicare and 20% to you. If you have a Medigap policy, the Medigap plan typically covers the 20% coinsurance and, depending on the plan letter (F or G), the deductible as well.

One practical note: how a mammogram is billed (screening vs diagnostic) is determined by the ordering physician's documentation and the reason for the order, not by which type of technology is used. A 3D mammogram ordered as a routine annual exam is billed as a screening; the same 3D technology ordered to evaluate a new symptom is billed as diagnostic. Confirm the billing category with your doctor's office before the appointment if you have questions about potential out-of-pocket cost.

3D Mammography (Tomosynthesis) Coverage Under Medicare

Digital breast tomosynthesis (DBT), commonly called 3D mammography, creates multiple X-ray images at different angles to build a layered view of breast tissue. Medicare covers 3D mammography under the same benefit as standard 2D mammography when a physician orders it as medically indicated. CMS added separate reimbursement codes for DBT in 2015, and the technology is now widely available at Medicare-certified facilities. For a screening mammogram, DBT is covered at zero cost to the patient, the same as 2D screening. For a diagnostic mammogram, the same 2026 cost-sharing rules apply: $283 deductible plus 20% coinsurance.

Research published in journals such as Radiology and the Journal of the National Cancer Institute shows 3D mammography detects more invasive cancers and reduces false positives compared to 2D alone. Because Medicare covers both at the same rate, the choice between 2D and 3D is driven by physician recommendation and facility availability, not by cost differences for the patient.

What Medicare Advantage May Add for Mammograms (2026)

Medicare Advantage plans (Part C) are required by law to cover everything Original Medicare covers, including the free annual screening mammogram. Mammography is classified as a preventive essential health benefit under ACA-compliant plans, which is why the zero-cost rule applies across Original Medicare and all Medicare Advantage options. Many Medicare Advantage plans go further by covering diagnostic mammograms with lower cost-sharing than Original Medicare, or by covering additional imaging services at no cost as part of a broader women's health preventive package. Some plans also waive the diagnostic mammogram coinsurance entirely. Check your 2026 Summary of Benefits or call your plan's member services line to confirm what applies to diagnostic mammography in your specific plan.

Special Needs Plans (SNPs), including Dual-Eligible Special Needs Plans (D-SNPs) for people who have both Medicare and Medicaid, typically cover mammograms at low or no cost even for diagnostic imaging, because the Medicaid component fills in the cost-sharing gap. If you are dual-eligible (about 12 million Americans have both Medicare and Medicaid coverage), your combined benefits may result in $0 out-of-pocket for both screening and diagnostic mammograms. Medicare Part A does not cover outpatient mammograms (Part A is inpatient hospital coverage only). Medicare Part D covers prescription drugs and does not apply to imaging services. All mammogram coverage runs through Medicare Part B for outpatient services.

Cost Without Coverage: What Mammograms Cost If You Pay Out of Pocket in 2026

For Medicare beneficiaries, the out-of-pocket cost after Medicare pays depends on the type of mammogram. Screening mammograms: $0 (fully covered as a preventive benefit). Diagnostic mammograms: typically $50 to $150 out of pocket after Medicare pays 80%, assuming a Medicare-approved facility charge in the $250 to $700 range for 2D imaging. 3D diagnostic mammograms: generally $75 to $200 out of pocket, as the Medicare-approved rate is slightly higher than 2D. For beneficiaries with a Medigap plan (F or G), both the deductible and coinsurance are typically covered, reducing diagnostic mammogram costs to near zero.

Without any insurance, cash-pay mammogram prices nationally range from $100 to $400 for a standard 2D screening and $150 to $550 for 3D tomosynthesis, according to FAIR Health 2026 data. Hospital outpatient radiology departments charge more than independent imaging centers. Some federally qualified health centers (FQHCs) offer sliding-scale or reduced-cost mammograms for uninsured or underinsured patients. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the CDC, also provides free or low-cost mammograms to low-income, uninsured, and underinsured women aged 21 to 64.

How to Schedule a Medicare-Covered Mammogram in 2026

Screening mammograms do not require a doctor's order under Medicare. You can self-refer directly to a Medicare-certified mammography facility. Diagnostic mammograms do require a physician referral or order. The steps below apply whether you are using Original Medicare or Medicare Advantage.

• Step 1: Confirm your Medicare Part B is active. Coverage is attached to Part B enrollment, which covers outpatient services including preventive screenings.
• Step 2: Find a Medicare-certified facility. Use the FDA MQSA facility locator at fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program/search-certified-facilities or the medicare.gov 'Find care' tool. Confirm the facility accepts Medicare assignment before booking.
• Step 3: Tell the facility it is an annual screening (not diagnostic) when scheduling, if you have no symptoms and it is your routine annual exam. This affects how it is billed and determines whether cost-sharing applies.
• Step 4: Bring your Medicare card (red, white, and blue card or Medicare Advantage plan card). No referral needed for screening. Bring a physician order for diagnostic mammograms.
• Step 5: After the appointment, review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to confirm the claim was processed as a preventive screening. If you receive a bill for a screening mammogram, contact 1-800-MEDICARE (1-800-633-4227).

Eligibility Criteria for Medicare Mammogram Coverage

To receive a Medicare-covered mammogram, you must be enrolled in Medicare Part B. Original Medicare requires Part B enrollment for any outpatient preventive service. Medicare Advantage enrollees have Part B included in their plan. The screening coverage criteria under Part B are: age 40 or older for the annual screening mammogram; age 35 to 39 for the one-time baseline screening mammogram. There is no lifetime visit limit for annual screening mammograms. Diagnostic mammograms have no specific age floor; Medicare covers them whenever a physician documents a clinical reason.

Medicare does not require a prior authorization for screening mammograms at Medicare-participating facilities. Diagnostic mammograms also generally do not require prior authorization under Original Medicare, though some Medicare Advantage plans do require it for diagnostic imaging. Check your plan documents or call your plan before scheduling a diagnostic mammogram if you are enrolled in Medicare Advantage.

Does Original Medicare cover mammograms for free?

Yes, for annual screening mammograms. Medicare Part B covers one screening mammogram per year for women aged 40 and older at $0 cost to you, with no deductible and no coinsurance. Diagnostic mammograms (ordered for a clinical reason) are covered but are subject to the 2026 Part B deductible of $283 and 20% coinsurance after the deductible is met.

Does Medicare Advantage cover mammograms?

Yes. Medicare Advantage plans must cover at least everything Original Medicare covers, including the free annual screening mammogram. Many Advantage plans also reduce or eliminate cost-sharing for diagnostic mammograms beyond what Original Medicare requires. Check your 2026 Summary of Benefits for your specific plan's mammogram cost-sharing rules.

What does a diagnostic mammogram cost on Medicare in 2026?

After Medicare pays 80% of the approved amount, you owe 20% coinsurance plus the 2026 Part B annual deductible of $283 if not already met. In practice, most beneficiaries pay $50 to $150 out of pocket for a diagnostic mammogram at a Medicare-participating facility. Medigap Plan F or G reduces this to near zero.

Does Medicare cover 3D mammograms (tomosynthesis)?

Yes. Medicare covers digital breast tomosynthesis (3D mammography) under the same cost structure as standard 2D mammography. Screening 3D mammograms are covered at no cost; diagnostic 3D mammograms are subject to the 2026 $283 deductible and 20% coinsurance. CMS added dedicated reimbursement codes for tomosynthesis in 2015, so coverage is widely available at certified facilities.

At what age does Medicare start covering mammograms?

Medicare Part B covers a one-time baseline mammogram for women between ages 35 and 39, then annual screening mammograms starting at age 40. The coverage at age 40 reflects the 2024 USPSTF guidance update. There is no upper age cutoff in the Medicare benefit; women over 74 are still eligible for the annual no-cost screening, though individual clinical guidelines may vary.

Do I need a doctor's referral for a Medicare-covered mammogram?

No referral is needed for a screening mammogram. You can schedule directly at any Medicare-certified mammography facility. A physician order is required for a diagnostic mammogram because it is ordered to investigate a specific clinical concern. You can find a certified facility using the FDA's MQSA locator or medicare.gov.

What if Medicare denies my mammogram claim?

If a claim is denied, first confirm whether it was billed as screening or diagnostic, since that affects coverage. Call 1-800-MEDICARE (1-800-633-4227) to ask for clarification. You have the right to file a formal appeal: request a redetermination from the Medicare Administrative Contractor within 120 days of the claim denial. If you believe the service should have been covered, the appeal process is free.

Can I get a mammogram covered by Medicare more than once a year?

For screening mammograms, Medicare covers one per year at no cost. Additional screening mammograms within 12 months are not covered at the preventive rate and would be subject to diagnostic billing rules. If your physician orders a second mammogram within the year due to a clinical concern, it would be billed as a diagnostic mammogram, which is covered but with the 2026 $283 deductible and 20% coinsurance.