Medicare covers MRI scans when a doctor deems them necessary for reaching a diagnosis.
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, a person may wonder how much of the cost Medicare will cover. Below, we answer this question and estimate out-of-pocket expenses. We also describe what happens at each stage of an MRI scan.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare considers MRI scans to be diagnostic non-laboratory tests. Medicare 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.
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 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 $203 in 2021.
Medicare Advantage
Medicare Advantage, also called 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 administer these plans. Part D is separate, 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, the out-of-pocket cost of an MRI scan can average $1,119. But most people with Medicare pay significantly less.
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 $8. Some people pay less, while others pay more.
If a person has an MRI scan at the hospital, the average cost is $16.
“MRI” stands for “magnetic resonance imaging.” It involves a machine taking digital images of the inside of the body.
A technologist takes the scan, and a radiologist reviews the images and creates a report for the doctor. The doctor then uses the information to identify an underlying health issue.
A doctor can use the information from an MRI scan to evaluate the:
- organs of the chest and abdomen, such as the heart, kidneys, liver, and bowel
- 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 provide information about the health of the brain and spinal cord.
An MRI scan may take
Preparation
Before the procedure, a doctor will ask the person if they:
- are pregnant
- have asthma or any allergies
- have any metal fragments in their body
- have an implanted electronic device, such as a pacemaker
- have an artificial joint
- have a medication pump, neurostimulator, artificial heart valve, cochlear implant, or brain aneurysm clip
During the scan
First, a person lies down on a table that slides into a large, doughnut-shaped machine. The technologist operating the machine may ask the person to hold their breath, depending on what part of the body they need to scan.
While in the machine, the person needs to close their eyes and remain still. The interior of the machine is lit, and there is a two-way intercom system, so the person and the technologist can speak at any point.
MRI machines usually make a loud banging sound, so the technologist may offer the person earplugs or headphones.
A person should let the technologist know if they experience any discomfort during the procedure. Also, a person can ask questions at any time — before, during, or after the scan.
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.