Does Medicare Cover Mammograms? 2026 Coverage and Cost Guide
"Does Medicare cover mammograms? Learn about 2026 coverage, screening costs, diagnostic mammograms, and Medicare Part B benefits."
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| Illustration. A doctor explains cancer examination and treatment to a patient at a hospital. |
Under Medicare Part B, women age 40 and older can receive a screening mammogram once every 12 months. Medicare also covers one baseline mammogram for women ages 35–39. When the screening mammogram is covered and the healthcare provider accepts Medicare assignment, the patient pays nothing for the screening test.
Diagnostic mammograms follow different cost-sharing rules. After the Part B deductible, patients generally pay 20% of the Medicare-approved amount for a diagnostic mammogram.
That distinction is important because an abnormal screening mammogram can lead to additional imaging that is no longer billed as routine preventive screening.
Medical information: This article explains Medicare coverage in general and is not a substitute for individualized medical, insurance or financial advice. Medicare rules, provider participation and plan requirements can affect what an individual patient pays.
Does Medicare Cover Mammograms?
Yes.
Medicare Part B covers:
one baseline mammogram for women ages 35–39;
screening mammograms once every 12 months for women age 40 and older;
diagnostic mammograms when medically necessary.
The 2026 Medicare & You handbook confirms that Medicare covers an annual screening mammogram for women age 40 and older.
Medicare also allows diagnostic mammography more frequently than once a year when medically necessary.
How Often Does Medicare Pay for a Mammogram?
For eligible women, Medicare Part B covers a screening mammogram once every 12 months.
This means Medicare does not generally limit an eligible woman to a mammogram every two years.
The Medicare schedule is separate from the screening intervals recommended by organizations such as the American Cancer Society and the U.S. Preventive Services Task Force.
For example, the ACS recommends annual mammography for women ages 45–54 at average risk, while the USPSTF recommends mammography every two years for women ages 40–74.
Medicare's coverage rule is therefore an insurance coverage rule, not a statement that every woman medically needs an annual mammogram.
Is a Medicare Mammogram Free?
For an eligible screening mammogram, you generally pay nothing when the healthcare provider accepts assignment.
Medicare's 2026 materials state that women age 40 and older pay nothing for an annual screening mammogram when the provider accepts assignment.
The same applies to the one-time baseline mammogram available to women ages 35–39.
However, "free mammogram" does not mean every breast-related medical service will have a $0 cost.
Additional diagnostic imaging, biopsies and other medically necessary services can have different cost-sharing.
What Is the Difference Between a Screening and Diagnostic Mammogram?
This is one of the most important things Medicare patients should understand.
Screening mammogram
A screening mammogram is performed to look for breast cancer in someone who does not have a specific symptom or abnormality requiring investigation.
Medicare covers eligible screening mammography once every 12 months.
Diagnostic mammogram
A diagnostic mammogram is used to investigate a breast concern.
It may be ordered because of:
an abnormal screening mammogram;
a breast lump;
nipple changes;
other breast symptoms;
or another finding that requires evaluation.
Medicare covers diagnostic mammograms when medically necessary, but the cost-sharing is different from screening mammography.
How Much Does a Diagnostic Mammogram Cost With Medicare?
Under Original Medicare, diagnostic mammograms generally have different cost-sharing from preventive screening mammograms.
Medicare states that after the Part B deductible is met, the patient generally pays 20% of the Medicare-approved amount for a diagnostic mammogram.
The actual amount can depend on:
the Medicare-approved amount;
whether the provider accepts assignment;
the setting where the service is performed;
whether other insurance covers some of the cost;
and whether additional services are required.
This is why a patient can have a $0 screening mammogram and later receive a bill for diagnostic follow-up.
Why Can You Get a Bill After a "Free" Mammogram?
Consider this example:
Routine screening mammogram
↓
Abnormal finding
↓
Diagnostic mammogram
↓
Possible ultrasound
↓
Possible biopsy
The initial screening may be covered without patient cost-sharing when Medicare requirements are met.
But subsequent diagnostic services are not necessarily treated as preventive screening.
Medicare specifically distinguishes diagnostic mammograms from screening mammograms.
Therefore, an unexpected bill after an abnormal screening result does not necessarily mean the original mammogram was billed incorrectly.
Does Medicare Cover 3D Mammograms?
Digital breast tomosynthesis, commonly called 3D mammography, is an established mammographic technology.
Medicare coverage depends on how the service is billed and whether the examination meets Medicare's coverage requirements.
Patients should confirm with the imaging facility that the planned examination is covered and ask whether there will be any additional patient cost.
Do not assume that every optional imaging service is automatically covered under exactly the same rules as a standard screening mammogram.
Before scheduling, ask:
"Is the 3D mammogram being billed as a Medicare-covered screening mammogram?"
Also ask whether any separate charge could apply.
Does Medicare Cover a Mammogram Every Year After Age 75?
Medicare's screening coverage is not limited to women through age 74.
Medicare states that it covers screening mammograms once every 12 months for women age 40 and older.
That is different from the USPSTF recommendation, which currently states that evidence is insufficient to determine the balance of benefits and harms of screening mammography in women age 75 and older.
The ACS also takes a different approach, recommending continued screening for women who remain in good health and are expected to live at least another 10 years.
This illustrates an important distinction:
Medicare coverage ≠ clinical screening recommendation.
Insurance coverage tells you what Medicare pays for under its rules.
A clinical guideline addresses whether screening is likely to benefit an individual.
Does Medicare Cover Mammograms for Women Ages 35–39?
Yes, but the coverage is limited.
Medicare Part B covers one baseline mammogram for women ages 35–39.
The baseline examination establishes a reference image that can be compared with future mammograms.
After age 40, Medicare covers screening mammography once every 12 months for eligible women.
Do You Need a Doctor's Referral for a Medicare Screening Mammogram?
CMS guidance states that a physician referral is not required for a screening mammogram.
However, individual imaging facilities may have their own scheduling or administrative requirements.
If you are scheduling a mammogram, ask the facility:
"Do you require an order or referral even though Medicare does not require one for screening mammography?"
This can prevent delays.
Does Medicare Require an FDA-Certified Mammography Facility?
Yes.
CMS states that Medicare-covered screening mammography must be performed by a supplier that meets the applicable certification requirements.
The Mammography Quality Standards Act requires mammography facilities to meet federal quality standards, and CMS states that Medicare will reimburse mammography performed by FDA-certified facilities.
When choosing an imaging center, patients should therefore consider both price and whether the facility is properly certified.
Does Medicare Cover Breast Ultrasound After a Mammogram?
Medicare can cover a medically necessary breast ultrasound when it is ordered by a healthcare provider.
The Medicare & You handbook notes that Medicare covers medically necessary breast ultrasounds when ordered by a doctor or other healthcare provider.
However, a breast ultrasound is not simply an automatic free replacement for mammography.
It may be used to investigate a particular finding or symptom.
If your mammogram leads to an ultrasound recommendation, ask whether the ultrasound is being performed for diagnostic reasons and what your expected cost-sharing will be.
Does Medicare Cover a Breast Biopsy?
When a biopsy is medically necessary to investigate a suspicious breast finding, Medicare may cover it under applicable Medicare rules.
However, a biopsy is a diagnostic procedure rather than a routine screening mammogram.
Therefore, patients should not assume that because their screening mammogram cost $0, every subsequent breast procedure will also cost $0.
Ask the healthcare provider and Medicare plan about:
the procedure;
facility charges;
pathology;
physician services;
and expected coinsurance.
Does Medicare Advantage Cover Mammograms?
Yes.
Medicare Advantage plans are required to cover Medicare-covered services, although the plan can have different networks, administrative procedures and cost-sharing rules.
Medicare explains that Original Medicare generally allows patients to use any doctor or hospital that accepts Medicare, while Medicare Advantage plans may require patients to use providers within the plan's network for non-emergency care.
Therefore, Medicare Advantage members should check their individual plan before scheduling.
Ask:
"Is this mammography center in my Medicare Advantage network?"
Also ask whether prior authorization, a referral or other plan-specific requirement applies.
Original Medicare vs. Medicare Advantage for Mammograms
| Issue | Original Medicare | Medicare Advantage |
|---|---|---|
| Annual screening mammogram | Covered if eligible | Covered |
| Screening cost | Generally $0 when provider accepts assignment | Plan-specific rules may apply |
| Diagnostic mammogram | Generally 20% after Part B deductible | Plan-specific cost-sharing |
| Provider choice | Broad nationwide Medicare provider access | Network rules may apply |
| Referral | Generally not required for screening mammography | Plan requirements can vary |
| 3D mammography | Coverage depends on applicable billing/coverage rules | Check individual plan |
| Follow-up imaging | Coverage depends on medical necessity and service | Plan-specific rules may apply |
The table is a simplified overview. Always check the current rules of your specific plan.
What Happens If My Mammogram Is Abnormal?
An abnormal mammogram does not automatically mean you have breast cancer.
Additional testing may be recommended to determine what caused the abnormal finding.
Depending on the situation, this may include:
diagnostic mammography;
breast ultrasound;
MRI in selected circumstances;
biopsy;
or short-term follow-up imaging.
The key Medicare issue is that these services may be classified differently from the original preventive screening mammogram.
If your screening mammogram is abnormal, ask:
"Is the next test being billed as diagnostic?"
That question can help you understand your potential out-of-pocket costs before the appointment.
Does Medicare Cover Mammograms for High-Risk Women?
Medicare covers eligible screening mammography according to its coverage rules.
However, women at substantially increased breast cancer risk may need a screening strategy that includes more than routine mammography.
For example, the American Cancer Society recommends annual breast MRI plus mammography for certain women whose estimated lifetime breast cancer risk is approximately 20%–25% or greater based on appropriate risk assessment tools.
Medicare coverage for additional imaging can depend on medical necessity and the specific service.
Therefore, a high-risk patient should discuss both questions separately:
What screening does my doctor recommend?
What will Medicare cover?
The answer to the first question does not automatically determine the answer to the second.
Does Medicare Cover Mammograms After Breast Cancer?
Patients with a previous breast cancer diagnosis may require surveillance or diagnostic imaging rather than average-risk screening.
Medicare can cover medically necessary mammography, but the way the examination is ordered and billed may differ from routine screening.
If you have previously been treated for breast cancer, ask your oncology or breast-care team:
"Is my next mammogram considered screening or diagnostic/surveillance imaging?"
This distinction can affect both coverage and cost-sharing.
Can Medicare Deny a Mammogram?
Medicare coverage depends on whether the service meets Medicare's requirements.
Potential issues can include:
the service being performed too frequently under the applicable coverage rule;
the examination not meeting medical-necessity requirements;
the facility not meeting applicable certification requirements;
billing or coding issues;
provider participation or assignment issues.
If you are told that a mammogram is not covered, ask the provider or Medicare why.
Do not assume that every mammogram is automatically covered simply because Medicare covers mammography as a category.
What Does "Accepts Assignment" Mean?
This phrase is important for Medicare patients.
When a provider accepts assignment, the provider agrees to accept the Medicare-approved amount as full payment for covered services, subject to applicable deductibles and coinsurance.
For screening mammograms, Medicare states that eligible patients pay nothing when the provider accepts assignment.
Before your appointment, ask:
"Do you accept Medicare assignment for mammography?"
This is especially useful if you are comparing imaging centers.
How to Check Your Mammogram Coverage Before the Appointment
A few simple questions can prevent unexpected costs.
Ask the imaging center
Do you accept Medicare?
Do you accept Medicare assignment?
Is this a screening or diagnostic mammogram?
Is the facility certified to perform Medicare-covered mammography?
Is 3D mammography included?
Will there be any separate facility or professional charge?
Ask Medicare or your plan
Is my mammogram covered?
Is this service preventive or diagnostic?
Does my deductible apply?
What percentage or copayment would I owe?
Do I need to use a particular facility?
Ask your doctor
Why am I having this mammogram?
Is it routine screening or diagnostic follow-up?
Will additional imaging likely be required?
Medicare Mammogram Cost: Quick Reference
| Situation | Medicare coverage and typical patient cost |
|---|---|
| Baseline mammogram, age 35–39 | One lifetime baseline mammogram; $0 when provider accepts assignment |
| Screening mammogram, age 40+ | Once every 12 months; $0 when provider accepts assignment |
| Diagnostic mammogram | Covered when medically necessary; generally 20% after Part B deductible |
| Breast ultrasound | Covered when medically necessary and ordered by a provider |
| Abnormal screening follow-up | May be billed as diagnostic rather than preventive |
| Medicare Advantage | Covered, but network and plan-specific cost rules may apply |
Does Medicare Cover a Mammogram Every 12 Months or Every 2 Years?
Every 12 months.
This is one of the most important answers for Medicare beneficiaries.
Medicare Part B covers an annual screening mammogram for eligible women age 40 and older.
However, Medicare's coverage interval should not be confused with medical guidelines.
A person should still discuss the appropriate screening schedule with a healthcare professional based on age, breast cancer risk, previous findings and overall health.
Questions to Ask Before Your Medicare Mammogram
Before scheduling, consider asking:
Is this a screening or diagnostic mammogram?
Is the facility Medicare-certified?
Do you accept Medicare assignment?
Is the screening covered once every 12 months?
Will I have any out-of-pocket cost?
Is 3D mammography included?
If the mammogram is abnormal, what happens next?
Would diagnostic imaging have different cost-sharing?
Is the facility in my Medicare Advantage network?
Do I need an order or referral?
The Bottom Line
Medicare does cover mammograms.
For women age 40 and older, Medicare Part B covers one screening mammogram every 12 months. For women ages 35–39, Medicare covers one baseline mammogram. Eligible patients generally pay nothing for these screening services when the provider accepts Medicare assignment.
Diagnostic mammograms are different. When medically necessary, Medicare covers them, but after the Part B deductible the patient generally pays 20% of the Medicare-approved amount.
The most important distinction is therefore:
Screening mammogram ≠ diagnostic mammogram.
A routine screening examination can be covered at $0, while additional imaging after an abnormal result can have different cost-sharing.
Medicare Advantage members should also check their plan's network and administrative requirements before scheduling.
If you are unsure about your coverage, ask the imaging center whether the appointment is being billed as screening or diagnostic and whether the facility accepts Medicare assignment.
Official Sources
This article was fact-checked against:
Medicare.gov
CMS
Medicare & You 2026
Medicare preventive-services guidance
Medicare coverage information can change. Patients should verify current coverage and cost-sharing directly with Medicare or their Medicare Advantage plan before receiving care.
Last reviewed for source accuracy: October 2026.
Medical disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Talk with your healthcare professional about the screening schedule appropriate for your individual breast cancer risk.