Medicare offers substantial coverage for mammograms and breast cancer surgeries, therapies and prostheses. What you’ll pay will depend on the extent of services required and whether you receive care as an outpatient or inpatient.
Screening and diagnostic mammograms
Medicare Part B, which covers outpatient services, pays 100% for a screening mammogram — an imaging technique that can detect some breast cancers — every 12 months for women age 40 or older. (Some people with disabilities are eligible for Medicare even if they are under age 65.)
A diagnostic mammogram is sometimes indicated when a screening mammogram shows possible signs of cancer, or when your doctor has other reasons to suspect cancer. You’ll owe 20% of the Medicare-approved charge after you pay the Part B deductible, which is $203 in 2021 (and rising to $233 in 2022). You’re covered for diagnostic mammograms more than once per year if medically necessary.
Breast cancer surgery and prostheses
If you need breast cancer surgery such as a mastectomy or lumpectomy, Medicare Part A covers services you receive if you’re admitted to a hospital, and Medicare Part B covers outpatient services.
For outpatient procedures such as some lumpectomies, you’ll owe 20% of the Medicare-approved charge after you pay the Part B deductible. For in-patient surgeries like mastectomy, you’ll pay the Part A deductible, $1,484 in 2021 ($1,556 in 2022); there is no coinsurance payment for your first 60 days in the hospital. A typical hospital stay for mastectomy is three days or less.
Reconstructive breast surgery is covered by Original Medicare. If, after mastectomy, you receive one or two surgically implanted breast prostheses in the hospital, Medicare Part A will provide coverage. If you receive an implant as an outpatient, Part B applies. Part B also covers some external breast prostheses, including a post-surgical bra.
Chemotherapy, radiation therapy and other services
Oncologists recommend chemotherapy and radiation therapy for many breast cancer patients. Even when these services are administered in a hospital facility, they are typically provided on an outpatient basis, so they’re covered by Medicare Part B.
Other services that Medicare may cover for breast cancer patients include:
- Related doctor visits.
- A second opinion on surgery, and a third opinion if the first two opinions differ.
- Physical therapy after surgery.
- Mental health services. Many women experience depression and anxiety related to breast cancer diagnosis and treatment.
If you have Medicare Advantage, contact your issuer to learn about costs and other coverage details.