Until the beginning of this year, if your doctor recommended you get a breast sonogram in addition to a mammogram as preventive care tests, Medicare would cover the full cost for both once a year. Now, Medicare will continue to cover the mammogram as a preventive service but will only cover the breast sonogram if it’s medically necessary.
When Medicare covers preventive care, it covers the cost in full. You do not first need to meet your deductible, and you have no coinsurance. Medicare covers a range of preventive care services, including wellness visits, vaccines, cardiovascular care, diabetes screening and more.
But, the Centers for Medicare and Medicaid Services has determined that, even for women with dense breasts, a routine annual sonogram is not a covered preventive service. In order for Medicare to cover the sonogram, your doctor must deem it to be medically necessary.
Medicare deems a breast sonogram necessary when there’s a need to distinguish between different types of masses, to assess the stability of a mass that a mammogram cannot discern, to check for implant issues or to plan for radiation treatment, evaluate breast lumps in nursing and pregnant women.
Here’s more from Just Care:
- Get the preventive care you need: Medicare pays for it
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- When to avoid preventive care services
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