Medicare covers MRI scans when a doctor orders the test as a necessary part of a medical diagnosis.
People in the United States can register for Medicare insurance when they reach the age of 65 years.
If a doctor recommends an MRI scan, a person may have questions about what portion of the costs that Medicare may cover, and which out-of-pocket costs they need to pay.
Read on to learn more about Medicare coverage and thepossible costs of an MRI scan.
Medicare covers MRI scans when a physician or other healthcare provider orders the MRI as an essential part of a medical diagnosis.
Traditional Medicare covers 80% of the cost of an MRI, as long as both the doctor who ordered the test and the medical facility where they perform it accept Medicare.
Medicare considers MRI scans as diagnostic non-laboratory tests. A person’s out-of-pocket cost for an MRI scan may vary depending on whether the person’s health insurance is traditional Medicare, a Medicare Advantage plan, or Medigap.
Medicare’s Price Lookup tool shows that the out-of-pocket cost for an outpatient MRI scan in a doctor’s office or non-hospital facility averages $8.
If a person receives an MRI scan at the hospital, the average cost is $15.
Most Medicare plans will cover the cost of an MRI scan in part or in full. A person’s out-of-pocket costs may vary depending on the Medicare plan or plans in which they are currently enrolled.
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 in the 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
Traditional Medicare and Medicare Part B may cover an MRI scan at a non-hospital facility.
Medicare Advantage (Part C)
Medicare Advantage, or Medicare Part C, is supplemental insurance 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 offer it as a separate plan for those enrolled in traditional Medicare.
A Medicare Advantage plan might also offer Medicare Part D.
A closed MRI scan can be stressful for some people. As a result, a physician may prescribe an antianxiety medication before the procedure. Medicare Part D may cover this drug.
MRI stands for magnetic resonance imaging. An MRI scan is a medical procedure that uses a machine to take a digital image of the inside of the body.
A radiologist will review the images and create a report for the doctor. The doctor will then use the information to try to understand what is causing the person’s symptoms.
A doctor can use information from an MRI scan to evaluate:
- organs of the chest and abdomen, including the heart, kidneys, liver, spleen, bowel, adrenal glands, and pancreas
- pelvic organs, including the bladder, colon, and rectum
- reproductive organs, such as the uterus, ovaries, and prostate gland
- blood vessels
- lymph nodes
MRI scans can also help when evaluating the brain and spinal cord.
An MRI scan may take
Before a person undergoes the procedure, a doctor will ask if they:
- are pregnant
- have any metal pieces or fragments in their body
- have an electronic medical device, such as a cardiac pacemaker
- have an artificial joint, such as a hip or knee
- have a medication pump, neurostimulator, artificial heart valve, cochlear implants, or brain aneurysm clips
What to expect
First, the person will lie down on a table. The table will then slide into a large, donut shaped machine for the procedure.
The technologist may ask the person to hold their breath for up to 30 seconds, depending on what part of the body they need to scan.
While in the machine, the person will remain lying down and close their eyes. They should try to relax and not move while the machine is running.
The interior of the machine is lit. A two-way intercom systemallows communication between the person and the technologist.
Because MRI machines usually make a loud banging sound while in operation, the technologist may offer the person earplugs or headphones.
The person will have access to a call button so that they may notify the technologist if they experience any discomfort during the procedure.
A person may ask questions at any time during the procedure — before, during, or after.
Several Medicare plans cover part of the cost of an MRI scan when a doctor finds that it is medically necessary to make a diagnosis.
Medicare covers 80% of the cost. The scan may be more expensive in a hospital than in a specialized clinic.
For more information about the cost of MRI scans, it is best to speak to the insurance provider directly.