Is an MRI covered by Medicare?
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Brad Larson
Licensed Insurance Agent
Brad Larson has been in the insurance industry for over 16 years. He specializes in helping clients navigate the claims process, with a particular emphasis on coverage analysis. He received his bachelor’s degree from the University of Utah in Political Science. He also holds an Associate in Claims (AIC) and Associate in General Insurance (AINS) designations, as well as a Utah Property and Casual...
Licensed Insurance Agent
UPDATED: Oct 22, 2024
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UPDATED: Oct 22, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance company and cannot guarantee quotes from any single insurance company.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
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Welcome to our comprehensive guide on Medicare coverage for MRIs. If you’re wondering, “Is an MRI covered by Medicare?” you’ve come to the right place.
In this article, we will delve into the details of Medicare coverage for MRIs, providing you with the information you need to make informed healthcare decisions. We’ll explore the eligibility criteria, potential costs, and any limitations or restrictions associated with Medicare coverage.
Additionally, we’ll touch upon other important topics related to insurance, such as understanding different Medicare plans, comparing rates, and finding the best insurance providers.
To get started on finding the right coverage for your needs, simply enter your zip code below and compare rates from top insurance providers in your area. Take control of your healthcare journey today!
- Medicare generally covers MRIs because doctors typically only request them when they are medically necessary
- There are several types of MRIs, each that looks into a different part of your body
- If you’re worried about Medicare coverage, you can purchase additional insurance through Medicare Advantage or Medigap to cover MRIs
Does Medicare cover an MRI?
The short answer to the question, “Does Medicare cover MRIs?” is usually yes. Medicare does pay for MRIs when they are considered medically necessary.
What typically covers MRIs is Medicare Part B. Medicare Part B covers outpatient services, such as doctor appointments, preventative services, and diagnostic tests (including MRIs).
If you happen to need an MRI while you’re in the hospital, Medicare Part A will cover your treatment. Medicare Part A includes inpatient treatment at hospitals and other approved facilities.
MRIs diagnose a range of internal complications. These scans are more powerful than X-rays and CT scans, so they are usually reserved for more complex issues.
There are several types of MRIs. Each type looks at different body parts and searches for different health complications.
Types of MRI
Type of MRI Part of the body Used to evaluate
Breast MRI Breasts Cancers and other abnormalities
Bone and Joint MRI Bones, joints, tendons, ligaments, muscles, and cartilage Injuries, cancer, masses, and infections
Brain MRI The brain and brain stem Headaches, strokes, aneurysms, seizures, blurry vision, and injuries
Magnetic Resonance Angiography Vascular system Blockages in veins and arteries
Spine MRI Spine Herniated or bulging discs, injuries, and other spinal diseases
Cardiac MRI Heart Heart attack damage, blood flow, heart defects, and tumors
Pelvic MRI Female reproductive system, Prostate gland Abnormalities in the uterus or ovaries and cancer
While they may seem intimidating, MRI scans with insurance can help save your life. If your doctor orders one, it’s crucial that you go through with it.
Medicare Advantage insurance does cover MRIs, as well. If Original Medicare isn’t enough, Medicare Advantage is a great place to start.
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How much does a Medicare MRI cost?
Many Americans assume that healthcare services are free under Medicare, but that isn’t correct. Like any other test or treatment, you will still have to pay for an MRI.
First, there is the cost of your deductible. In 2021, the price of Medicare Part B’s deductible is $203 per benefit period. In 2022, that number will rise to $217.
After you’ve met your deductible, you’re responsible for paying your coinsurance fee. Medicare Part B covers 80% of services, like MRIs. That leaves you with the remaining 20%.
The average price of an MRI in America is $2,611. How much does Medicare pay for an MRI? It depends on the type of MRI you receive, where you receive it, and how much your doctor charges, but you can expect to pay much less than you would without insurance.
The good news is that Medicare does cover MRI scans very well. How much does an MRI scan costs with Medicare? According to Medicare.gov, the average price for an MRI brain scan without contrast is $60 in an outpatient setting.
Medicare MRI Guidelines
When you need an MRI, Medicare can help, but only if you meet specific guidelines. Like all other healthcare services, Medicare MRI coverage depends on three criteria:
- Your doctor must request the procedure as medically necessary
- You must have the procedure done at a Medicare-approved facility
- Your doctor must accept Medicare and Medicare assignment
If you meet those criteria, it’s likely that Medicare will cover MRI scans for you.
Medicare Does Cover MRI Scans — Find the Best Option for You
Because insurance covers MRIs, people with Medicare should feel at ease with this diagnostic test. If the price is still too high, you can also look into Medicare Advantage or Medigap to gain additional coverage.
The good news is that the answer to, “Does Medicare cover an MRI” is usually yes. However, if you think you need additional coverage, you should shop around to find the best rates.
If you’re ready to see what quotes might look like for you, then enter your ZIP code into our free tool.
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Case Studies: Is an MRI covered by Medicare?
Case Study 1: John’s Diagnostic MRI
John, a Medicare beneficiary, experienced persistent back pain and sought a diagnostic MRI recommended by his physician. Since his condition required further investigation, Medicare Part B covered the cost of his MRI scan. John only had to pay his deductible and coinsurance, as required by his plan.
Case Study 2: Sarah’s Preventive MRI
Sarah, a Medicare beneficiary with a family history of breast cancer, wanted to undergo a preventive MRI screening for early detection. Unfortunately, Medicare does not cover preventive screenings like MRI for most conditions. In Sarah’s case, Medicare did not cover the cost of her preventive MRI, and she had to pay for it out of pocket.
Case Study 3: Michael’s Emergency MRI
Michael, a Medicare beneficiary, was rushed to the emergency room due to severe head trauma after a fall. As part of his emergency care, an MRI was performed to assess the extent of his injuries. In this case, Medicare Part A covered the cost of the emergency MRI since it was deemed medically necessary to evaluate and treat his condition.
Case Study 4: Lisa’s Advanced Imaging Center
Lisa, a Medicare beneficiary, was referred to an advanced imaging center by her specialist for an MRI scan. Unfortunately, the imaging center she chose was not enrolled in Medicare and did not accept Medicare assignment. Consequently, Lisa had to bear the full cost of the MRI out of pocket, as Medicare could not reimburse her for services obtained from non-participating providers.
Frequently Asked Questions
Is an MRI covered by Medicare?
Yes, an MRI (Magnetic Resonance Imaging) can be covered by Medicare.
What are the requirements for Medicare to cover an MRI?
Medicare covers MRIs if they are deemed medically necessary by a doctor to diagnose or treat a medical condition. The MRI must also be performed at a facility that accepts Medicare.
How much does Medicare cover for an MRI?
Medicare covers 80% of the cost of an MRI. The remaining 20% is the responsibility of the patient, unless they have a Medicare Supplemental Insurance plan that covers the cost.
Are there any limitations or restrictions on Medicare coverage for an MRI?
Yes, there may be some limitations or restrictions on Medicare coverage for an MRI. For example, Medicare may only cover an MRI once every 12 months for certain conditions. Also, certain types of MRIs, such as whole-body MRIs, may not be covered by Medicare.
How do I know if an MRI is covered by Medicare?
The best way to know if an MRI is covered by Medicare is to ask your doctor or the facility where the MRI will be performed if they accept Medicare. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to find out if a specific MRI is covered.
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Brad Larson
Licensed Insurance Agent
Brad Larson has been in the insurance industry for over 16 years. He specializes in helping clients navigate the claims process, with a particular emphasis on coverage analysis. He received his bachelor’s degree from the University of Utah in Political Science. He also holds an Associate in Claims (AIC) and Associate in General Insurance (AINS) designations, as well as a Utah Property and Casual...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.