Does Medicare cover ultrasound for dense breast tissue?
Medicare covers ultrasound for dense breast tissue when it is medically necessary. While Medicare covers mammograms as screening tools for breast cancer, ultrasound for dense breast tissue is only covered as a diagnostic tool. Ultrasound for dense breast tissue is covered under Medicare Part B and is subject to a deductible and coinsurance. Medicare Advantage plans may have different coverage for breast ultrasound.
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UPDATED: Jan 21, 2021
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- Medicare covers ultrasound for dense breast tissue only if medically necessary
- A mammogram is the only screening tool covered as a preventative test for breast cancer
- Breast ultrasound is covered under Medicare Part B and is subject to a deductible and coinsurance of 20 percent
Does Medicare cover ultrasound for dense breast tissue? Medicare will cover breast ultrasound for diagnostic purposes when it is medically necessary. For breast cancer screening purposes, only mammograms are covered by Medicare in full. If your doctor determines that a breast ultrasound is required due to dense breast tissue or for any other medically necessary reason, you will pay the Part B deductible as well as 20 percent coinsurance. Medicare Supplement insurance can cover all or part of this out-of-pocket amount.
You may also want to consider a Medicare Advantage health insurance plan, which often includes additional coverage not available with original Medicare.
If you would like to shop for a Medicare plan to cover breast ultrasound for dense breast tissue, enter your ZIP code now.
What coverage for breast ultrasound for dense breast tissue is included with Medicare?
If your doctor determines that further testing is required after a regularly scheduled screening mammogram or a diagnostic mammogram, you may be eligible for a breast ultrasound. This is usually done when dense breast tissue makes it difficult to view cancerous masses on standard mammography.
A screening mammogram is covered for all women on Medicare at regular intervals and is covered as preventative care. A breast ultrasound is usually treated not as preventative but as a diagnostic tool and is treated that way under your coverage.
Because Medicare Advantage plans are run by private health insurance companies, they can offer some slightly different coverage. Check with your plan provider to see what is covered.
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What is the cost of breast ultrasound for dense breast tissue with Medicare?
Breast ultrasound is covered when necessary under Medicare Part B. That means it’s subject to the Part B deductible as well as coinsurance. After your deductible is met, Medicare will cover 80 percent of the cost. If you have Medicare Supplement insurance it will pay for all or part of the deductible and 20 percent health care coinsurance cost, depending on the plan you have.
Your cost with a Medicare Advantage plan will differ depending on your coverage details. Each Medicare Advantage plan has its own deductibles and coinsurance amounts. Check with your plan provider to find out how much it will cost you.
Does Medicare cover ultrasound for dense breast tissue? The Bottom Line
Medicare covers ultrasound for dense breast tissue when it is determined to be medically necessary. It will be covered under Medicare Part B and subject to a deductible and coinsurance. You can get some or all of those costs covered with a Medicare Supplement plan.
To compare your options for a Medicare plan that covers breast ultrasound for dense breast tissue, enter your ZIP code now.