- Once women are 40 years old, they should get screening mammograms every year.
- Most insurance plans, including Medicare and Medicaid, offer 100% coverage for approved mammogram costs.
- Women who are underinsured or uninsured can also afford mammograms thanks to government and private programs.
- Mammogram facilities are required to adhere to federal standards, giving you confidence in your mammogram regardless of cost.
Early cancer detection saves lives, and breast cancer early detection is no different. Diagnostic tools like mammograms and MRIs can help detect breast cancer sooner and increase the rate of survival.
Mammograms are used alongside self-breast exams and clinical breast exams as part of routine breast cancer screening. Mammograms can be expensive, but thankfully, several resources ensure all women can access life-saving screening tests.
What Is a Mammogram?
A mammogram is a diagnostic tool that uses X-ray technology to take pictures of the breasts. During a mammogram, the breasts are flattened with gentle pressure from a plate to help the radiologist get the best views of breast tissue.
In addition to self-breast exams and clinical breast exams, mammograms are used to screen for breast cancer. Mammograms can detect breast cancer that your health care provider may not be able to feel on a clinical breast exam.
Mammograms have been proven to improve a patient’s odds of curing their breast cancer and living longer, making them a key component to women’s health and wellness.
While typically painless, mammograms can cause slight discomfort when the breasts are flattened. The procedure takes less than 30 minutes.
Who Should Have an Annual Mammogram?
According to the American Cancer Society (ACS) and other well-respected organizations like the American College of Obstetrics and Gynecology (ACOG), women should start having annual mammograms when they turn 40 years old.
This is because most breast cancers are found in women who are at least 50 years old. Also, the biggest risk factor for developing breast cancer is age.
However, women who are considered to have a higher than average risk of developing breast cancer may need to start regular screening mammograms sooner.
How Much Does a Mammogram Cost?
Will My Insurance Company Pay for My Mammogram Cost?
Typically, insurance companies will consider covering screening recommendations made by healthcare experts.
Specifically, the Institute of Medicine helps guide the recommendations made by the Health Resources and Services Administration (HRSA). These determine what screening services are necessary for a woman’s health and well-being. Necessary services should be covered partly or in full by health plans so patients can access these screening tests.
In the case of screening mammograms, many insurance companies will cover the mammogram cost.
Actually, the Affordable Care Act mandates that screenings for women’s preventive health care be covered without any cost-sharing.
This means screening mammograms, screenings for cervical cancer, and other services should be 100% covered by insurance plans without a copay required by the patient. Screening mammograms are also covered by Medicare and Medicaid.
Simply put, if you qualify for a screening mammogram and have insurance, you most likely don’t have to pay for the test, regardless of your deductible structure.
But, as with most things healthcare plan-related, it’s best to call your insurance company to verify any mammogram costs you may be responsible for.
How Do I Qualify for Insurance Coverage for My Mammogram?
Using the HRSA Women’s Preventive Services Guidelines, you should start regular breast cancer screening mammograms when you turn 40 years old.
The guidelines recommend screening yearly or every other year. Women should have screening mammograms until they are at least 74 years old, but age alone shouldn’t be a reason to stop breast cancer screening.
These guidelines are for women with an average risk of developing breast cancer. If you’re considered high-risk for breast cancer, you may be able to get your screenings covered before you turn 40.
Women who are considered high-risk typically have a strong family history of breast cancer or genetic markers like BRCA1 and BRCA2 mutations. If you’re not sure of your breast cancer risk level, talk to your healthcare provider.
Does Insurance Cover 3-D Mammography?
3D mammography, or digital breast tomosynthesis, has become popular and more available in the last several years.
Like the traditional 2D mammogram, 3D mammography uses X-ray images, but it takes many more images. These images are then used to create a three-dimensional image of the breast, allowing for a more detailed look.
3D mammography is now covered by most health insurance companies, including Medicare and Medicaid. However, not all facilities currently have 3D mammography technology.
Can I Get a Mammogram Without Insurance?
The short answer is yes–women without insurance can have a mammogram without paying excessive costs. Several private and federally funded programs have been created to increase access to valuable screening services like mammograms.
Over 30 years ago, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided the development of a nationwide early cancer detection program.
This program spans 50 states, six U.S. territories, and 13 Native American tribal organizations to increase access to mammograms and other cancer screening tools for women.
Congress and the Centers for Disease Control determined mammogram costs should not keep women from getting routine screenings. Other programs have been established with the help of Congress to bring screening mammograms to low-income, underinsured, and uninsured women.
If you don’t have insurance and need a mammogram, these programs will take a look at your eligibility, including age, income, and insurance status.
Privately funded foundations, including the Brem Foundation and the Susan G. Komen Breast Cancer Foundation, provide resources to women who need help with mammogram costs.
In addition, during Breast Cancer Awareness month in October, many clinics offer reduced cost or free mammograms.
Does Low-Cost or No-Cost Mean Low Quality?
Mammogram facilities are certified by the U.S Food and Drug Administration (FDA). The FDA requires all mammogram facilities to meet certain standards when it comes to the equipment they use and the authorized personnel using the equipment.
These standards were developed under the Mammography Quality Standards Act of 1992. The FDA has a list (updated weekly) of all the FDA Certified Mammography Facilities. Check this list before scheduling your screening.
Take Charge of Your Health With Early Screening for Breast Cancer
In addition to mammograms, women may need a breast MRI to take a closer look.
By using magnets and radio frequencies, breast MRIs create detailed images of breast tissue. Breast MRIs are helpful in women with dense breast tissue, as this density makes mammogram images less clear.
Mammogram cost should not be a barrier to breast cancer screening. If you’re still unsure how to pay for your mammograms, your healthcare team can help you find resources.
To decide whether you need a 3D mammogram, a traditional mammogram, or a mammogram and MRI, talk with your healthcare provider. They’ll help you understand the best breast imaging option for you.
If you want to be proactive before deciding what screening test you may need, take our five-minute online assessment. This short evaluation helps you determine your risk for breast cancer and other cancers.