Women generally know their medical insurance covers their yearly mammogram after age 40 (plus one baseline mammogram after 35) in full. What gets confusing is knowing when co-pays and deductibles may apply. We’ll try to clear that up.
- Medical insurance plans always cover your basic annual mammogram with NO copay or deductible.
- Most plans cover 3D with no deductible, because 3D has tremendous benefits. However:
- Some plans will apply the cost of 3D to your deductible, and require you to pay that.
- Some plans from other states resist paying for 3D, especially for a baseline mammogram.
- For some perspective on this cost, Medicare pays $65 for 3D, but plans vary.
- Your plan may require you to pay a copay or deductible for other procedures.
- This includes ultrasound, Dexa, diagnostic mammogram or a biopsy.
- Medicare and Medicaid cover all recommended procedures.
- The Medicare deductible ($185 in 2019) may apply to procedures other than your annual 3D mammogram.
If you do not have insurance, our cash price is the Medicare rate. For example, a complete 3D mammogram is $225. We never charge anyone an extra fee; some sites charge a “facility fee” which can raise your bill by $800. Even if you have insurance, you or your employer ultimately pays that charge.
Please call your insurance company if you have questions about your coverage, or call our billing office if you have questions about your bill.