Medicare covers screening mammograms for free.
But breast ultrasounds are also recommended for many women, especially those with dense breast tissue.
This article will explain when Medicare pays for breast ultrasound and how much it will cost.
Verywell / Michela Buttignol
Men also can get breast cancer; it is estimated that approximately 2,800 will be diagnosed this year.
The Affordable Care Act (Obamacare) changed how many women get screened for cancer.
Rates for advanced cancers decreased by 11% in states that expanded Medicaid under Obamacare.
Transgender individuals are also covered if the mammogram is considered medically appropriate based on their situation.
Screening vs.
Diagnostic Mammograms
Screening mammograms look for cancer in people who do not have symptoms.
Diagnostic mammograms are for people who have symptoms.
Although screening mammograms are free, you will pay 20% for a diagnostic mammogram.
Mammograms and Dense Breasts
Breasts are composed of fatty, fibrous, and glandular tissue.
Mammograms look at this tissue using X-rays.
Fat appears dark on X-rays, while glands and fibrous connective tissue appear white.
Cancerous changes, like clusters of calcium (breast calcifications) or tumors, can look white too.
As many as 48% of women have dense breast tissue.
To be clear, dense breasts are a radiologic finding, not something you’re able to feel.
What Is Sensitivity?
A test that has high sensitivity is less likely to give a negative result when you have cancer.
The higher the sensitivity, the better.
Likewise, some women can develop complications from their breast implants.
Breast Cancer in Men
Screening tests for cancer are done before you have any symptoms or signs.
They may also have a condition likeKlinefelter syndromethat predisposes them to cancer.
Regardless of risk, if a person develops symptoms, they should be evaluated with diagnostic imaging.
Symptoms may include breast pain, a breast lump, skin changes, or unexplained nipple discharge.
An ultrasound makes sense as an initial imaging test.
Abreast ultrasoundis a relatively low-cost test that uses sound waves to generate an image of the breasts.
Using a mammogram and breast ultrasound together improves the detection of breast cancer in people with dense breasts.
More breast cancers are detected thanks to breast ultrasound.
This can lead to unnecessary worry and testing.
Medicare Coverage for Breast Ultrasound
Medicare pays for tests it considers to be medically necessary.
With that in mind, it is not surprising that Medicare covers breast ultrasounds for anyone who has symptoms.
However, unlike a screening mammogram, the test will not be free.
You will pay 20% toward the cost of a breast ultrasound if one is deemed medically necessary.
These plans help pay for any out-of-pocket expenses that Medicare leaves behind.
Plans K and L only cover 50% or 75% of your coinsurance.
Cancer can be missed in anyone with dense breasts.
Medicare covers breast ultrasound for this very reason.
As always, it is important to talk with your doctor.
American Cancer Society.Limitations of Mammograms.
National Breast Cancer Foundation.Breast Cancer facts and stats.
Center for Medicare Advocacy.Medicare Enrollment Numbers.
Kaiser Family Foundation.A Profile of Medicare-Medicaid Enrollees (Dual Eligibles).
2020;155(8):752-758. doi:10.1001/jamasurg.2020.1495
National Center for Transgender Equality.What does Medicare cover for Transgender people?
American Cancer Society.Medicare coverage for cancer prevention and early detection.
American Cancer Society.Breast density and your mammogram report.
National Cancer Institute.Dense breasts: Answers to commonly asked questions.
Centers for Disease Control and Prevention.Dense breasts.
Radiological Society of North America.Digital mammography increases breast cancer detection.
U.S. Food and Drug Administration.Risks and complications of breast implants.
American Cancer Society.Can breast cancer in men be found early?
American Cancer Society.Risk factors for breast cancer in men.
National Health Services.Breast cancer in men.
2019;365:l1652.
2019;109(5):762-767. doi:10.2105/AJPH.2019.304967
Vourtsis A, Berg WA.Breast density implications and supplemental screening.Eur Radiol.
2019;29(4):1762-1777. doi:10.1007/s00330-018-5668-8
Centers for Medicare and Medicaid services.Compare Medigap plan benefits.
