Does Medicare Cover Mammograms? Screening vs. Diagnostic Costs (2026)
Reviewed October 8, 2026. Yes, Medicare Part B covers mammograms. If you’re a woman with Medicare age 40 or older, Part B covers a screening mammogram once every 12 months, and you pay nothing if your provider accepts assignment. Diagnostic mammograms, which are done to check a lump, symptom or abnormal result, are also covered when medically necessary, but you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026).
Quick answer: Screening mammogram: once every 12 months at age 40 and older, $0 with a provider who accepts assignment. Baseline mammogram: once in your lifetime between ages 35 and 39. Diagnostic mammogram: as often as medically necessary, 20% coinsurance after the deductible.
Does Medicare cover mammograms?
Medicare covers three kinds of mammograms under Part B (Medicare.gov: Mammograms):
| Type of mammogram | Who’s covered | How often | What you pay (2026) |
|---|---|---|---|
| Baseline mammogram | Women ages 35 to 39 | Once in your lifetime | Nothing if the provider accepts assignment |
| Screening mammogram | Women 40 and older | Once every 12 months | Nothing if the provider accepts assignment |
| Diagnostic mammogram | When medically necessary | As often as medically necessary | 20% of the Medicare-approved amount after the $283 Part B deductible |
Sources: Medicare.gov and the CMS 2026 Part B premiums and deductibles fact sheet. Medicare.gov’s mammogram page doesn’t list an upper age limit for screening.
Screening vs. diagnostic mammograms
The difference matters because it changes what you pay.
- Screening mammogram: A routine check when you have no breast symptoms. It’s a Medicare preventive service, so you pay nothing when your provider accepts assignment. Medicare.gov says you pay nothing for most preventive services from providers who accept assignment (Medicare.gov: Preventive and screening services).
- Diagnostic mammogram: Done when you have a symptom, such as a lump or nipple discharge, when a screening mammogram finds something that needs a closer look, or to follow up on past breast cancer. It’s covered as a diagnostic test, so the Part B deductible and 20% coinsurance apply.
If a screening shows something and you’re called back for more images, the follow-up is diagnostic. Ask the imaging center ahead of time how a callback would be billed.
Breast ultrasound and other follow-up tests
Medicare.gov says breast ultrasounds are covered only when medically necessary and ordered by your provider. They’re not part of the free screening benefit, so expect the usual Part B deductible and 20% coinsurance. If you need a biopsy or treatment, those are covered under the normal Part A or Part B rules. Our guide to Medicare coverage of MRIs explains imaging costs, and Medicare and cancer patients covers treatment.
Clinical breast exams
Separately from mammograms, Medicare covers a clinical breast exam as part of the pelvic exam in its cervical and vaginal cancer screening benefit. That’s generally covered once every 24 months, or every 12 months if you’re at high risk, and you pay nothing if your provider accepts assignment (Medicare.gov: Cervical and vaginal cancer screenings).
What a diagnostic mammogram costs with Medicare
Your share depends on the Medicare-approved amount where you live and whether you’ve met your deductible. As an illustration only: if the Medicare-approved amount for a diagnostic mammogram is $200 and you’ve already met the 2026 Part B deductible, Medicare pays $160 and you pay $40. If you haven’t met the deductible yet, you pay the approved amount up to what’s left of your $283 deductible, then 20%.
A Medigap plan can cover some or all of that coinsurance. If you have limited income, a Medicare Savings Program can help with Part B costs. For more on the deductible, see Medicare Part B deductible 2026.
Mammograms with Medicare Advantage
Medicare Advantage plans must cover everything Original Medicare covers, including screening and diagnostic mammograms. Plans can require you to use in-network imaging centers and may need a referral for diagnostic tests, so check your plan’s rules and copays for diagnostic imaging before you book. If you’re comparing plans, see Medicare Advantage HMO vs. PPO.
How to get a Medicare-covered mammogram
- Check timing. For screening, it needs to have been at least 12 months since your last screening mammogram.
- Choose a provider that accepts assignment. Use Medicare’s Care Compare tool to find imaging centers and doctors.
- Book it as a screening if you have no symptoms. If you have symptoms, tell your doctor. A diagnostic mammogram is the right test, even though it costs more.
- Ask questions if something else is recommended. Medicare.gov notes your doctor may recommend services Medicare doesn’t cover or covers less often, which could cost you extra.
What to check before your appointment
A few quick checks can prevent a surprise bill:
- Is it at least 12 months since your last screening? Medicare counts the time between screenings. A screening done a few weeks early may not be covered as a free screening.
- Does the imaging center accept assignment? That’s what makes the screening $0 under Original Medicare. If you’re in a Medicare Advantage plan, confirm the center is in network.
- How is the order written? If your doctor’s order says “diagnostic,” the deductible and coinsurance apply. If you have no symptoms, ask whether a screening order is appropriate.
- Are you being asked to sign a notice? If a provider gives you an Advance Beneficiary Notice of Noncoverage (ABN), it means they think Medicare may not pay. Read it before you sign.
- Do you have other coverage? Retiree coverage, Medicaid or a Medigap policy can change what you owe for diagnostic tests. Our guide to Medicare coordination of benefits explains who pays first.
Mammograms if you have Medicare and Medicaid
If you have both Medicare and full Medicaid, Medicare pays first for your mammogram. Medicaid may then cover the Part B deductible and coinsurance for diagnostic tests, as long as you use providers that work with both programs. If you’re enrolled in a Medicare Savings Program, the program may also cover Part B cost sharing, depending on the program level. See dual eligibility in Medicare and Medicaid.
Mammograms are one of several cancer screenings Medicare covers. See also Medicare coverage of colonoscopies.
Frequently asked questions
How often does Medicare pay for a mammogram?
Medicare pays for one screening mammogram every 12 months if you’re 40 or older, and one baseline mammogram between ages 35 and 39. Diagnostic mammograms are covered as often as medically necessary.
Is there an age limit for Medicare mammograms?
Medicare.gov lists screening coverage for women 40 and older and doesn’t list an upper age limit. Talk with your doctor about whether yearly screening still makes sense for you.
Do I need a referral for a screening mammogram?
Original Medicare doesn’t require a referral for a screening mammogram. Medicare Advantage plans may have their own referral rules, so check your plan.
Does Medicare cover 3D mammograms?
Ask your imaging center how your exam will be billed before you go. Medicare.gov’s coverage page describes screening and diagnostic mammograms without separating 2D and 3D exams.
Why did I get a bill after my “free” mammogram?
Usually because the exam was billed as diagnostic, the provider didn’t accept assignment, or additional images or an ultrasound were done. Check your Medicare Summary Notice, and call the provider if the billing looks wrong.
Does Medicare cover mammograms for men?
Medicare.gov describes the screening mammogram benefit for women. If a man has a breast lump or other symptom, his doctor can order the diagnostic tests that are medically necessary, which Part B covers under its usual rules for diagnostic tests.
This article is general information, not medical or individual insurance advice. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.