Yes, Medicare covers mammograms under Part B, but what you pay depends on whether the mammogram is a screening or a diagnostic exam. Routine screenings cost nothing if your provider accepts Medicare assignment. Diagnostic mammograms, ordered when your doctor suspects a problem, carry the standard Part B deductible of $283 in 2026 and 20% coinsurance after that.1Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Parts A & B Premiums and Deductibles2Medicare.gov. Mammograms
Screening Mammograms
Women aged 40 or older get one screening mammogram every 12 months at no cost. There is no deductible, no coinsurance, and no copayment as long as the provider accepts Medicare assignment.2Medicare.gov. Mammograms Women between 35 and 39 are covered for a single baseline mammogram.3Medicare. Your Guide to Medicare Preventive Services
The frequency rule is slightly more generous than an annual limit suggests. Medicare will pay for a new screening once at least 11 months have passed after the month of your last screening.4Centers for Medicare & Medicaid Services (CMS). NCD – Mammograms (220.4) A January screening can be repeated the following January.
Both standard 2D digital mammograms and 3D breast tomosynthesis are covered at $0 under the screening benefit, even though the facility bills a separate add-on code for the 3D imaging.2Medicare.gov. Mammograms
Diagnostic Mammograms
A diagnostic mammogram is ordered when there is a specific reason to look more closely: a lump, breast pain, nipple discharge, an abnormal screening result, or a personal history of breast cancer or biopsy-proven benign breast disease. After you meet the Part B annual deductible of $283 in 2026, Medicare pays 80% of the approved amount and you pay the remaining 20%.2Medicare.gov. Mammograms1Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Parts A & B Premiums and Deductibles
There is no frequency limit on diagnostic mammograms. Medicare covers them as often as a doctor considers medically necessary. And unlike screening coverage, diagnostic mammograms are covered regardless of the patient’s sex when ordered by a doctor of medicine or osteopathy for someone with signs or symptoms of breast disease or a qualifying history.4Centers for Medicare & Medicaid Services (CMS). NCD – Mammograms (220.4)
When a Screening Turns Into a Diagnostic Exam
This is where most billing surprises come from. You arrive for a routine screening expecting to pay nothing. The radiologist reviews the images while you are still at the facility, decides additional views are needed, and the visit splits into two services on the same day: the screening and a new diagnostic mammogram.5CMS (Centers for Medicare & Medicaid Services). Billing and Coding Guidelines Diagnostic Mammogram (RAD-005)
The screening portion still costs you nothing. The diagnostic portion, however, carries the Part B deductible and 20% coinsurance like any other diagnostic mammogram. If you have not yet met your deductible for the year, the diagnostic portion draws from it first. You often will not see the cost difference until your explanation of benefits arrives.
Medicare Advantage Plans
Every Medicare Advantage plan must cover at least what Parts A and B cover, so screening mammograms remain $0.6Medicare. Compare Original Medicare & Medicare Advantage For diagnostic mammograms, cost-sharing can look different: some plans charge a flat copayment instead of 20% coinsurance, and many plans cap your total annual out-of-pocket spending in ways Original Medicare does not.
The tradeoff is network. Non-emergency care is generally expected to come from providers inside the plan’s network, and using an out-of-network facility for a diagnostic mammogram can mean paying significantly more or having the claim denied.6Medicare. Compare Original Medicare & Medicare Advantage Frequency rules for particular services can also vary by plan.3Medicare. Your Guide to Medicare Preventive Services Check your evidence of coverage or call the plan before scheduling.
Cutting the 20% With Medigap
If you have Original Medicare and want to reduce or eliminate the 20% coinsurance on diagnostic mammograms, a Medicare Supplement Insurance (Medigap) policy can help. Plans C, D, F, G, and M cover 100% of Part B coinsurance. Plan K covers 50%, Plan L covers 75%, and Plan N covers Part B coinsurance with small copayments possible for certain office and emergency room visits.7Medicare.gov. Compare Medigap Plan Benefits
One restriction matters. Plans C and F are not available to people who turned 65 on or after January 1, 2020. For anyone who became Medicare-eligible after that date, Plan G is generally the most comprehensive option for Part B cost-sharing.7Medicare.gov. Compare Medigap Plan Benefits Medigap works only alongside Original Medicare; it cannot be used with a Medicare Advantage plan.
What You Need in Place
Mammogram coverage runs through Part B. Enrollment requires paying a monthly premium of $202.90 in 2026, higher for people whose income exceeds certain thresholds.1Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Parts A & B Premiums and Deductibles Without Part B, mammograms are not covered under Original Medicare at all.
The free screening also depends on where you go. The $0 cost applies only when the provider accepts Medicare assignment. A facility that does not accept assignment can bill you more than the Medicare-approved amount. Before scheduling, confirm that both the imaging facility and the radiologist reading your images participate in Medicare.2Medicare.gov. Mammograms