Does Medicare Cover MRI Scans?

Yes, Medicare covers Magnetic Resonance Imaging (MRI) scans. If your doctor orders an MRI to diagnose or treat a medical condition, Medicare Part B will cover it as a diagnostic non-laboratory test.

But knowing that Medicare covers the scan is only half the battle. The real question is how much of the bill you'll be responsible for. That depends entirely on which of the two Medicare paths you've chosen to walk down.

The insurance industry loves to make this complicated, but it's not. You have two choices: Traditional Medicare (Parts A and B) or Medicare Advantage (Part C). The supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, not an alternative to Advantage. Let's look at how your MRI is handled under both paths.

Path 1: Traditional Medicare (with or without a Supplement)

Under Traditional Medicare, Part B covers 80% of the Medicare-approved amount for your MRI. You are responsible for the remaining 20%, plus the Part B deductible if you haven't met it yet for the year.

If you have a Medicare Supplement (Medigap) plan, it steps in to pay that 20% coinsurance. Depending on your specific Medigap plan, you might pay absolutely nothing out of pocket for the scan once your Part B deductible is met. Remember, benefits are standardized by federal law - a Plan G from one company covers the exact same gaps as a Plan G from another.

Path 2: Medicare Advantage (Part C)

If you chose a Medicare Advantage plan, your coverage works differently. These plans must cover everything Traditional Medicare covers, including MRIs, but they set their own cost-sharing rules.

Instead of a flat 20%, you will typically pay a copayment for the MRI. This copay can range from $50 to several hundred dollars, depending on your specific plan. You also need to make sure the imaging center is in your plan's network, and your plan may require prior authorization before you can get the scan.

What You Need to Know Before Your Scan:

• Medical Necessity: Medicare only covers MRIs when they are ordered by a doctor treating a specific medical problem. They are not covered for routine screening.
• Location Matters: Where you get the MRI can affect your cost. Scans done in a hospital outpatient department often cost more than those done in an independent freestanding imaging center.
• Contrast Dye: If your MRI requires contrast dye, Medicare covers that as part of the procedure.

You've worked hard for your money, and you shouldn't have to guess what a medical test will cost you. If you're on Traditional Medicare and tired of worrying about that 20% bill, a Medigap plan can protect what you've earned.