Yes. Medicare covers yearly mammograms after age 75. Medicare Part B pays for one screening mammogram every 12 months for women 40 and older, with no upper age limit and no out-of-pocket cost when the provider accepts assignment.1Medicare.gov. Mammograms At 75, 85, or 95, you are entitled to the same annual screening coverage as a woman decades younger.
What Part B Pays For at 75 and Beyond
Part B treats a screening mammogram as a preventive service. If the facility accepts Medicare assignment, meaning it agrees to accept the Medicare-approved amount as full payment, you pay nothing for the screening itself and cannot be balance billed.2Medicare. Does Your Provider Accept Medicare as Full Payment?
You do not need a doctor’s order or referral. A CMS transmittal states plainly that a physician’s order is not required for screening mammography to be covered.3Centers for Medicare & Medicaid Services. Transmittal 1519 You can call a mammography facility and book the appointment yourself.
The 12-Month Rule Matters More Than the Calendar
Medicare counts months, not years. If your last screening mammogram was on March 15, 2025, the next covered one is March 15, 2026, at the earliest.1Medicare.gov. Mammograms Scheduling a few weeks early can leave you owing the full cost. Track the date yourself rather than trusting the scheduler.
Why Your Doctor May Not Push for One After 75
Coverage and clinical recommendation are two different things. The U.S. Preventive Services Task Force recommends biennial screening mammograms for women 40 through 74 and assigns screening after 75 an “I” grade, meaning the evidence is insufficient to weigh the benefits and harms.4U.S. Preventive Services Task Force. Final Recommendation Statement: Screening for Breast Cancer That is not a recommendation against screening. It means the age group has not been studied enough for a firm call.
Some physicians stop routinely ordering mammograms at 75; others weigh a patient’s overall health, life expectancy, family history, and personal preferences. If your doctor hasn’t raised the subject, ask. Medicare’s coverage doesn’t mean every physician will proactively order the test, and the task force’s silence doesn’t mean the test is wrong for you.
When a Free Screening Turns Into a Bill
The most common billing surprise in breast imaging: you arrive for a no-cost screening, the radiologist sees something that needs another view, and the visit is reclassified as diagnostic. The moment additional images are ordered for a specific finding, the cost structure changes.
Diagnostic mammograms are ordered when something specific needs investigating, whether that’s a lump, breast pain, an abnormal screening result, or monitoring after a breast cancer diagnosis. Medicare Part B covers them whenever they are medically necessary, with no annual frequency limit.1Medicare.gov. Mammograms After you meet the annual Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount.5Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles On a $150 diagnostic mammogram, your share after the deductible is $30.
You usually can’t stop the reclassification during the visit, and the extra images are typically needed. But knowing it can happen prevents sticker shock when the bill arrives.
3D Mammograms
Three-dimensional mammography, or digital breast tomosynthesis, takes images from multiple angles to build a layered picture and can pick up cancers that flat 2D imaging misses, particularly in dense breast tissue. Medicare covers 3D mammograms for both screening and diagnostic use under Part B.1Medicare.gov. Mammograms Used as a screening tool with a provider who accepts assignment, it costs you nothing. Diagnostic 3D mammograms follow the same 20% coinsurance rule after the deductible.5Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
Covering the 20% Coinsurance
If you have Original Medicare and want protection against the coinsurance on diagnostic mammograms, a Medigap policy can pick up that share. Most Medigap plan letters cover 100% of the Part B coinsurance; Plans K and L cover 50% and 75% respectively.6Medicare. Choosing a Medigap Policy
Medicare Advantage plans must cover everything Original Medicare covers, so screening mammograms remain no-cost.1Medicare.gov. Mammograms Diagnostic cost-sharing is set by the plan, so check the Evidence of Coverage or call the plan for the exact copay or coinsurance at an in-network facility.
If You Get a Bill You Didn’t Expect
Incorrect coding is a frequent cause of unexpected mammogram bills, usually a screening visit billed as diagnostic. Before the appointment, confirm the facility accepts Medicare assignment and, if you have no symptoms, confirm with your doctor that the order is for a screening. Afterward, check your Medicare Summary Notice. If a screening was billed as diagnostic, call the facility’s billing department first and ask them to resubmit with the correct code.
If billing won’t correct the claim, or Medicare denies coverage you believe you are entitled to, you can request a redetermination using CMS Form 20027, the first level of Medicare appeal. You generally have 120 days from the date on your Medicare Summary Notice to file.7Centers for Medicare & Medicaid Services. Medicare Redetermination Request Form – 1st Level of Appeal Keep a copy of your doctor’s order and the date of your last screening; both make disputes easier to resolve.