Does Medicare Advantage cover MRI Knee?

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.

Diagnostic Imaging

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

Medicare Part B covers MRI Knee 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 MRI Knee? (2026)

Q: Does Medicare cover MRI Knee?

Yes. Medicare Part B covers medically necessary mri knee. 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 medically necessary MRI Knee at 80% after you meet the Part B deductible. You pay the other 20% as coinsurance, with no annual out-of-pocket maximum under Original Medicare.

Quick answer:

Medically necessary MRI Knee (Original Medicare): Part B - 80% after deductible
Your share: 20% coinsurance (no cap under Original Medicare)
Prior authorization: Not required under Original Medicare; varies under Medicare Advantage
Annual Part B deductible (2026): $257

What Medicare Covers

Medicare Part B covers diagnostic imaging that is:

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Ordered by a Medicare-enrolled physician for a documented medical reason
Performed at a Medicare-enrolled facility
Medically necessary per LCD (Local Coverage Determination) criteria

MRI Knee is always diagnostic under Medicare - there is no $0 preventive category for MRI Knee as there is for mammograms or colonoscopies.

Your Medicare Cost for a MRI Knee

Phase	What you pay
Before Part B deductible ($257/year) is met	100% of the Medicare allowed amount
After Part B deductible	20% of the Medicare allowed amount
With Medigap supplement	Medigap pays the 20% coinsurance in full
With Medicare Advantage	Varies by plan - may be a flat copay

The Medicare allowed amount for MRI Knee varies by setting:

Hospital outpatient (HOPD): Higher allowed amount
Freestanding imaging center: Lower allowed amount; usually lower cost to you

Medicare Advantage (MRI Knee)

Medicare Advantage plans (Part C) cover the same medically necessary services as Original Medicare, but apply their own cost-sharing structures. Differences from Original Medicare:

Prior authorization: Medicare Advantage plans CAN require prior authorization for MRI Knee - a critical difference from Original Medicare
Network restrictions: You must use in-network facilities (most MA plans)
Cost sharing: May be a flat copay ($50–$200 typical) instead of 20% coinsurance
Out-of-pocket maximum: MA plans have an annual cap; Original Medicare does not

Two Bills Under Medicare

Like commercial insurance, Medicare MRI Knee generates two claims:

Technical fee (facility): Paid at 80% by Medicare
Professional fee (radiologist): Paid at 80% by Medicare separately

Both the facility and the radiologist must be enrolled in Medicare (accept Medicare assignment) for Medicare to cover them.

Related Cost Information

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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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