Medicare covers MRI scans when a doctor deems them necessary for reaching a diagnosis. These scans may be covered by Part A, Part B, or Medicare Advantage.
Most people in the United States can register for Medicare insurance when they reach the age of 65. People with certain health conditions, such as end stage renal disease, are eligible sooner.
If a doctor recommends an MRI scan in order to confirm a diagnosis, then certain parts of Medicare may cover all or part of the costs involved.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare considers MRI scans to be diagnostic non-laboratory tests. It covers these scans when a physician or another healthcare professional orders one as an essential step toward a diagnosis.
The out-of-pocket price of a scan can vary, depending on whether a person has Original Medicare or a Medicare Advantage plan.
Read more about Original Medicare vs. Medicare Advantage.
Medicare Part A
Medicare Part A covers inpatient hospital care, home healthcare, skilled nursing facility care, and hospice care.
If a doctor orders an MRI scan while a person is admitted to a hospital, Medicare Part A may cover a portion of the cost.
Medicare Part B
Medicare Part B covers medically necessary services, including:
- outpatient services
- durable medical equipment
- ambulance services
- home health services
- preventive services
Medicare Part B may cover up to 80% of the cost of an MRI scan at a non-hospital facility — as long as both the doctor who ordered the scan and the medical facility that performs it accept Medicare. A person’s Part B deductible applies, which is $240 in 2024.
Medicare Advantage
Medicare Advantage (Part C) is an alternative to Original Medicare that Medicare-approved private insurance companies can administer.
People with Medicare Advantage plans should contact their insurance provider to find out how much they may need to pay out of pocket for an MRI.
Medicare Part D
Medicare Part D provides outpatient prescription coverage. Private insurance companies administer these plans. Part D is a separate plan and not part of Original Medicare.
A Medicare Advantage plan might also include the coverage that Part D offers.
Some people find being confined in a closed MRI machine stressful, and in this case, the doctor may prescribe an antianxiety medication. Medicare Part D may cover the cost.
According to the Kaiser Family Foundation (KFF), the out-of-pocket cost of an MRI in 2018 scan averaged $1,119. But most people with Medicare pay significantly less than the average cost.
Medicare’s Price Lookup tool shows that the out-of-pocket cost of an outpatient MRI scan in a doctor’s office or another non-hospital facility averages $9. Some people pay less, while others pay more.
If a person has an MRI scan at the hospital, the average cost is $17.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
When a doctor needs an MRI scan to make a diagnosis, Medicare provides coverage.
Medicare Part B may cover 80% of the cost if the scan takes place at a non-hospital facility, and MRIs may be more expensive when a hospital performs them.
For more information about the cost of an MRI scan, it is best to speak to the insurance provider directly.