Does Medicare Advantage cover Mammogram?

Yes. Medicare Advantage plans must cover the same medically necessary services as Original Medicare. Cost sharing differs - usually a flat copay instead of 20% coinsurance. Medicare Advantage plans may require prior authorization even when Original Medicare does not.

What is the Medicare Part B deductible in 2026?

The 2026 Part B deductible is $257. You pay this amount once per year before Medicare starts covering its 80% share. A Medigap supplement policy (Plan G, Plan N, etc.) can cover this deductible for you.

Does Medigap (Medicare supplement) cover my coinsurance?

Yes. Most Medigap plans (Plan G, Plan F, Plan N) cover the 20% coinsurance you owe after Original Medicare pays its 80% share. Plan G is the most comprehensive supplement currently available to new Medicare enrollees.

Preventive / Breast

John Caruso, FSA, MAAA • June 26, 2026 • 7 min read

Medicare Part B covers Mammogram at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.

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Does Medicare Cover Mammograms? (2026)

Q: Does Medicare cover Mammogram?

Yes. Medicare Part B covers medically necessary mammogram. You pay 20% coinsurance after the $257 Part B deductible (2026). Original Medicare has no annual out-of-pocket cap - Medigap supplements fill this gap.

Yes. Medicare Part B covers screening mammograms at no cost (no deductible, no coinsurance) for women age 40 and older, once every 12 months. Diagnostic mammograms are covered at 80% after the Part B deductible - you pay 20%.

The screening is free. The diagnostic follow-up, if you need one, isn't - and that switch from "$0" to "20% coinsurance" is exactly the kind of thing that catches people off guard. Here's how to know which one applies to you.

Quick answer:

A screening mammogram is $0 - until a callback or a symptom re-codes it as diagnostic and the bills start.

Your personalized cost report includes:

✓ When a "free" screening becomes a cost-shared diagnostic mammogram - and how to see it coming
✓ The separate radiologist bill most patients miss (and how to verify it's in-network)
✓ Why a hospital outpatient department can cost far more than a breast center for the identical study
✓ When 3D tomosynthesis adds a separate charge - and the questions to ask before you schedule
✓ A real patient billing breakdown, line by line

Free for patients - takes 30 seconds to get.

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Screening mammogram (age 40+, annually): $0 - no deductible, no coinsurance
Diagnostic mammogram: 80% covered after $257 Part B deductible - you pay 20%
Prior authorization: Not required under Original Medicare

Screening Mammogram Under Medicare

Medicare Part B covers one screening mammogram every 12 months for women age 40 and older. This coverage is:

$0 out-of-pocket - the Part B deductible does NOT apply to screening mammograms
Annual (not biennial - more frequent than some commercial ACA plans)
At a Medicare-enrolled facility and read by a Medicare-enrolled radiologist
CPT code 77067 (digital) or 77063 (tomosynthesis add-on)

Note on 3D mammography (tomosynthesis): Medicare covers 3D digital breast tomosynthesis as part of the screening mammogram. It should be covered at $0 when billed alongside the screening code.

Diagnostic Mammogram Under Medicare

A diagnostic mammogram - ordered to evaluate a symptom, abnormal finding, or after a prior screening flagged an area of concern - is covered at the standard Part B cost-sharing:

Medicare pays 80% of the allowed amount
You pay 20% coinsurance AFTER the $257 annual Part B deductible
Medigap (supplemental policies) generally pay the 20% coinsurance

Medicare Advantage (Part C)

Medicare Advantage plans cover screening mammograms at $0 (required by CMS) and diagnostic mammograms at plan cost-sharing. Some MA plans apply a copay for diagnostic mammograms. Check your plan's Summary of Benefits.

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About the Author

John Caruso, FSA, MAAA

Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.

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