Medicare pays for one screening mammogram every 12 months for women 40 and older, and that includes women over 70. There is no upper age limit. Whether you’re 72, 80, or 95, Medicare Part B covers a screening mammogram once a year at no cost to you.
Medicare’s Coverage Rules After 70
Medicare’s mammogram policy is straightforward: if you’re a woman enrolled in Part B and you’re 40 or older, you’re eligible for one screening mammogram every 12 months. The benefit doesn’t expire at 70, 75, or any other age. As long as you have Part B coverage, the screening is available to you every year for the rest of your life.
Screening mammograms covered by Medicare are considered preventive care, which means you pay nothing out of pocket. The Part B deductible does not apply, and there’s no 20% coinsurance. This zero-cost rule holds regardless of your age.
If you’re on a Medicare Advantage plan rather than Original Medicare, your plan is required to cover at least the same preventive benefits, including annual screening mammograms. Some Advantage plans offer additional perks like transportation to appointments, but the core coverage frequency is the same.
Why Medical Guidelines Differ From Medicare Rules
Here’s where it gets a little confusing. Medicare covers mammograms annually with no age cap, but the U.S. Preventive Services Task Force (the independent panel that sets national screening recommendations) draws a line at 74. The USPSTF recommends screening every other year from age 40 through 74, giving this a “B” grade. For women 75 and older, the Task Force says there simply isn’t enough evidence to recommend for or against continued screening.
That “insufficient evidence” label doesn’t mean mammograms stop working after 74. It means the clinical trials that proved screening saves lives mostly didn’t include enough older women to draw firm conclusions for that age group. One large study using Medicare claims data from over a million women found that continuing annual screening between ages 70 and 74, rather than stopping at 70, was associated with a 22% lower risk of dying from breast cancer.
The practical takeaway: Medicare will pay for it, but the decision about whether to keep getting screened after 74 becomes more personal. Your doctor can help weigh the benefits against your overall health, life expectancy, and preferences.
Screening vs. Diagnostic Mammograms
The once-every-12-months rule applies specifically to screening mammograms, which are routine checks when you have no symptoms. If your doctor orders a diagnostic mammogram because of a lump, breast pain, or an abnormal finding on a previous screening, that’s a separate category. Medicare covers diagnostic mammograms as medically necessary services, and they aren’t limited to once a year. You can have as many as your doctor orders.
The cost structure is different, though. Diagnostic mammograms may involve the Part B deductible and the standard 20% coinsurance, depending on the circumstances and your supplemental coverage. If a screening mammogram turns up something that needs a closer look and you’re called back for a diagnostic follow-up, that second visit falls under diagnostic rules.
What Counts as 12 Months
Medicare measures the 12-month interval from the date of your last screening mammogram. If you had your last one in March 2024, you’re eligible again in March 2025. You don’t need to wait until January of a new calendar year. Some women accidentally space their mammograms further apart than necessary because they think the benefit resets with the calendar year, but it’s simply 12 months from your previous screening date.
If you schedule a screening slightly before the 12-month mark (say, at 11 months), Medicare may deny the claim. It’s worth confirming the timing with your provider’s billing office if you’re scheduling close to the cutoff.
3D Mammograms and Facility Requirements
Many imaging centers now offer 3D mammograms (also called tomosynthesis), which create a layered image of the breast and can be especially helpful for women with dense breast tissue. Medicare does cover 3D mammograms, though coverage details and any additional out-of-pocket costs can vary. Ask the facility before your appointment whether the 3D component is fully covered under your plan.
Regardless of the type of mammogram, Medicare only pays for services performed at facilities certified under the Mammography Quality Standards Act. These facilities must meet federal standards for equipment, radiation dose, image quality, and staff qualifications, and they’re inspected at least once a year. Virtually all major hospitals and imaging centers carry this certification, but if you’re using a smaller or mobile clinic, it’s reasonable to confirm.