Does Medicare cover mammograms and breast cancer treatment?

Indeed! Medicare covers some of the costs of mammograms and other breast cancer treatments, but there are some limitations.

Medicare coverage for breast cancer depends on exactly what type of treatment you’re receiving. For example, if you’re having a biopsy, an ultrasound, or other diagnostic tests, or any therapy such as radiation therapy or chemotherapy, Medicare is likely to pay for these.

However, if you need surgery to remove your breast, that’s another story.

Many beneficiaries don’t realize that Medicare doesn’t cover this procedure, as it comes under cosmetic procedures unless it’s related to a biopsy that indicates the presence of a tumor.

Besides these limitations, most of your expenses will be covered if you are treated for breast cancer under Medicare Part B. This includes any tests, medications, or procedures your doctor performs as part of your treatment plan.

All you need to do is make sure that your doctor has agreed to accept the Medicare assignment for the medical services provided.

Let’s explore more about Medicare coverage on breast cancer and treatment.

Medicare and Breast Cancer Screening or Mammograms

What are Mammograms?

Mammograms are used to screen breast cancer before it may be detected by any other means. They are also used to detect breast cancer that is not otherwise apparent or suspected, and they can be one of the tools used by doctors to plan treatment.

Two Types of Mammograms:

• Digital mammograms are the most common type and use a special machine called a digital mammogram unit. The machine takes pictures of breast tissue and compresses it to get a clear picture.
• Film-screen mammograms is the oldest type of screening test and gives the best results on dense breasts, which are found primarily in younger women. This type of mammography uses X-ray film but still gives high-quality images.

These tests can help find early signs of breast cancer, but they do not diagnose it. That’s why it’s important to talk with your doctor about all your options before you decide which test is proper for you.

Is Medicare Willing to Pay for All Types of Mammograms?

In short, yes! Medicare is willing to pay for all screening and diagnostic mammograms.

However, there are a few limitations that you must know.

Traditional Medicare, mainly Part B, provides screening mammograms once in 12 months. The screening mammogram will be free if the provider accepts Medicare. Medicare Part B also covers diagnostic screening only if the physician has referred for one.

Part B will also cover more than one diagnostic screening if it is required to diagnose breast cancer or the physician finds the traces of cancer.

However, Part B will only cover 80% of the Medicare-approved amount for the diagnostic mammogram. The rest of the 20% will be paid by you, including deductibles, if any.

Talking about Medicare Advantage coverage for mammograms, it is quite similar to Traditional Medicare. 

Part C will cover the screening mammograms only if the patient visits the in-network provider. Medicare Advantage also covers diagnostic mammograms, but it pays only a part of the cost, as Original Medicare does.

Medicare and Breast Cancer Treatment

Medicare Part B covers most of the cost of chemotherapy, hormone therapy, and surgery. These are considered medically necessary treatments for breast cancer and therefore are covered by Original Medicare.

Although, Medicare coverage isn’t the end of the story. Doctors and hospitals must accept the terms of your Medicare plan; otherwise, the government health insurance program will not be able to reimburse them. However, private insurance may require referrals or prior approval before paying for your treatment.

In addition to paying for some breast cancer treatments, Medicare will also pay for:

• Diagnostic services, such as X-rays, blood tests, and mammograms, or biopsies.
• Procedures to remove breast lumps or tissue samples (as long as they’re being done to test if a lump is cancerous).

FAQs on Medicare and Mammograms

Q. What is the Typical Cost of a Mammogram?

The typical cost ranges from $40 to $250, depending on where you live and the type of coverage you have.

Medicare Part B or Medicare Advantage both covers;

• 100 percent cost of yearly screening mammograms
• 80 percent cost of diagnostic mammograms

Q. Are Mammograms Covered Under Medicare Part B?

The U.S. Department of Health and Human Services states that mammograms are “covered as part of the diagnostics for breast cancer when ordered by a doctor for a patient.” However, in the past, CMS consistently ruled that mammograms were covered under Part B, which provides outpatient medical services.

Q. What Types of Mammograms Does Medicare Cover?

The three main types of Mammograms that Medicare Covers are;

• Conventional Mammogram
• Digital Mammogram
• 3-D Mammogram

Not every provider offers 3-D mammograms, and that’s why it is necessary to consult the doctor and the insurance provider.

Q. Is Chemotherapy Covered by Medicare Parts A & B?

Chemotherapy is covered by Medicare Part A if you’re a hospital inpatient. Medicare Part B provides coverage if you receive chemotherapy in an outpatient setting, such as a doctor’s office or freestanding clinic.

However, where you get the therapy may impact how much you pay. For example, you’ll pay 20 percent of Medicare-approved costs in an outpatient setting and the Part B deductible. In contrast, inpatient will only invite copayment, covered by Part A.

Also, Medicare Part D covers some of your chemotherapy treatments and related prescription drugs.

Conclusion

It can be shocking for the patients to realize that they were living with breast cancer, and neither can be easy to digest. And that’s why it is necessary to get screening if you have noted any similar medical conditions in the family.

Therefore, it is also necessary to discuss these medical conditions with your agents before enrolling in a plan. You might not have any symptoms developing the tumor now, but considering such medical histories when enrolling in a coverage helps you make better decisions.

If you’re planning to enroll in Medicare and don’t know what plan is suitable for you, consult our licensed insurance agent specializing in Medicare for a suitable plan.