Medicare pays for one screening mammogram every 12 months at no cost to you. There’s no deductible and no coinsurance for screening mammograms, as long as your provider accepts Medicare assignment. Diagnostic mammograms, ordered when something needs a closer look, are covered more frequently but come with cost sharing.
Screening Mammograms: Once Every 12 Months
Medicare Part B covers one screening mammogram per year for all enrolled women. The official rule from the Centers for Medicare and Medicaid Services is that at least 11 months must pass after the month of your last screening mammogram before Medicare will pay for the next one. So if you had a screening mammogram in January, the earliest Medicare would cover another is the following January.
This is a fully covered preventive service. You pay nothing out of pocket: no Part B deductible, no 20% coinsurance. That zero-cost rule applies to both Original Medicare and Medicare Advantage plans, though with Medicare Advantage you’ll need to use an in-network provider.
There is no upper age limit on this coverage. Medicare will continue paying for annual screening mammograms past age 74. This is worth noting because the U.S. Preventive Services Task Force only recommends routine screening through age 74 and says there isn’t enough evidence to assess the benefits and risks beyond that age. Medicare’s coverage is more generous than the task force guidelines in another way, too: the USPSTF recommends screening every two years starting at age 40, while Medicare covers it annually.
Diagnostic Mammograms Cost More
If your doctor orders a mammogram because of a symptom, an abnormal screening result, or a lump found during an exam, that’s classified as a diagnostic mammogram. Medicare covers diagnostic mammograms as often as medically necessary, with no once-per-year limit. The cost sharing is different, though. You’ll first need to meet your Part B deductible, then you pay 20% of the Medicare-approved amount for the test.
This distinction catches some people off guard. A screening mammogram that comes back abnormal often leads to a follow-up diagnostic mammogram within weeks, and that second test falls under the diagnostic rules. You could go from paying nothing for the first test to owing a share of the second, even though both happened in the same year. If you’re on a Medicare Advantage plan, check your plan’s specific cost sharing for diagnostic imaging, since it can vary.
Clinical Breast Exams Have a Separate Schedule
Medicare also covers a clinical breast exam (a physical exam done by your provider) as part of a package that includes a Pap smear and pelvic exam. This is covered once every 24 months for most women, or once every 12 months if you’re at high risk for cervical or vaginal cancer or have had an abnormal Pap smear in the past 36 months. Like screening mammograms, these exams are covered at 100% with no deductible or coinsurance when you see a participating provider.
One thing to watch for: if your provider discovers a new issue during a preventive visit and begins investigating or treating it on the spot, that additional care is considered diagnostic. Medicare can bill you for the diagnostic portion even though the preventive screening itself was free.
The 11-Month Rule in Practice
The 11-month waiting period is counted from the month of service, not the exact date. If your mammogram was on March 15, 2024, you’re eligible again in March 2025, not necessarily on March 15. This gives you some flexibility in scheduling without worrying about hitting the exact anniversary date.
Where people run into problems is scheduling a mammogram too early. If you had one in late December and try to schedule the next one in the following November, Medicare will deny the claim. Your provider’s office should check your last screening date before booking, but it’s worth keeping track yourself. If a claim is denied because of timing, you’ll be responsible for the full cost.
No Extra Screenings for High-Risk Patients
Medicare does not offer more frequent screening mammograms for women at higher risk of breast cancer, including those with BRCA gene mutations or a strong family history. The rule is the same for everyone: one screening mammogram after at least 11 months have passed since the last one. If your doctor believes you need imaging sooner based on your risk profile, that would be ordered as a diagnostic mammogram, which Medicare covers when medically necessary but with the standard 20% coinsurance after your deductible.
The USPSTF has noted that there isn’t yet sufficient evidence to recommend supplemental screening with breast ultrasound or MRI for women with dense breast tissue. Medicare’s coverage reflects this: routine supplemental imaging beyond a standard mammogram isn’t part of the standard preventive benefit. Your doctor can still order additional imaging when clinically justified, but it will typically fall under diagnostic coverage with cost sharing.