Will Medicare pay for an ultrasound scan of my breast?

Here’s how Medicare pays for breast screenings in general: For women on Medicare due to disability, the program covers annual screening mammograms for those 40 or older. If you join Medicare at 65 or later, it will cover the full cost of annual screenings. There is no age cutoff.

The situation changes if you are getting a diagnostic mammogram, which physicians may order if a lump or another breast issue emerges. In this case, you are subject to the 20 percent coinsurance under Medicare Part B. (Some Medigap plans cover it. Medicare Advantage charges vary by plan.)

Now to your question: Sometimes, when a patient has a problem or dense breast tissue, a doctor will order an ultrasound, which generates a more detailed scan than a mammogram. If your doctor says you need an ultrasound or other scan when it’s “reasonable and necessary for the diagnosis or prevention of illness or disability,” Part B will cover it with the same 20 percent coinsurance requirement. Note: Medicare Advantage plans must cover all Part B services that original Medicare does, but are allowed to ask for a doctor’s preauthorization to show that an additional test is medically necessary.

I’m on Medicaid and Medicare. If I lose my Medicaid eligibility due to the pandemic’s end, will that affect my Medicare?

Losing Medicaid coverage has no bearing on your eligibility for Medicare. But the change in your situation could make you want to switch your Medicare coverage, which you can do without penalty within three months of the state telling you your Medicaid coverage is ending or when your Medicaid ends, whichever is later.

For those who were eligible for Medicare but were enrolled only in Medicaid, you can enroll now in Medicare without any late penalties. You have six months after your Medicaid coverage ends to sign up for Parts A and B. You can enroll in a Part D prescription drug plan within three months of getting notice that you’re entitled to sign up for Medicare.