In many cases, Medicare does cover the cost. Your magnetic resonance imaging (MRI) exam may be covered under original Medicare. However, it would help if you met specific criteria. Your out-of-pocket expenses for a scan depend on whether you have a Medicare Advantage or Medicare Supplement (Medigap) plan as well.
The medical facility at which you receive the rest and your residence location may also impact the costs. In most cases, Medicare beneficiaries’ prescribed diagnostic tests are covered under Original Medicare. Medicare Advantage or Medigap insurance plans may offset most or all of the cost of a physician-ordered scan.
MRI Scan as a Diagnostic Tool
Doctors may use a diagnostic test to confirm many health conditions or injuries e.g., torn ligaments, aneurysm, or stroke.
Medicare typically covers the cost of your test under the following scenarios:
- Your doctor, who accepts Medicare patients, ordered or prescribed the test.
- The test was necessary as a diagnostic tool to assist in treating a medical condition.
- The test was performed at an imagining center or hospital that accepts Medicare. If you have Original Medicare, you pay 20 percent of the cost of the test unless you previously met this year’s deductible.
Coverage under Medicare
Medicare.gov reports that the average Medicare beneficiary pays between $59-$95 out-of-pocket for a magnetic resonance imaging scan of the brain.
Without Medicare insurance coverage, the costs of the test maybe thousands of dollars. The procedure may be more expensive depending on your medical factors, e.g., when special contrast dyes are used.
Medicare Parts A and B
Original Medicare Parts A and B may be used to pay for your MRI:
- Part A pays for care received in the hospital. If the doctor orders a diagnostic test during your hospital stay, Medicare Part A is used to pay for the treatment.
- Part B pays for the MRI if you receive the test as an outpatient. Medicare Part B is used to pay for supplies and medical services you receive to treat any health condition, with the exclusion of prescription medicines. Under Original Medicare, Part B covers up to 80 percent of the test’s costs.
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Medicare Part C (Medicare Advantage)
Also called Medicare Advantage, Medicare Part C is a private insurance plan used to cover what Medicare does and doesn’t pay.
Medicare Part C isn’t automatically included with Original Medicare. It may be possible to sign up for some Medicare Advantage Plans without paying a monthly premium. Contact your insurance agent to estimate how much money you’d save on the exam after enrolling in Medicare Advantage.
Medicare Part D
Part D offers prescription drug coverage. If you’re a Medicare beneficiary and you’re asked to take a drug before the scan, e.g., an anti-anxiety medication to help you stay relaxed in a closed field, your Part D plan may cover the cost. To learn more about Medicare plans, visit Clearmatch Medicare.
Medicare Supplement Insurance Plans (Medigap Plans)
Medicare supplement insurance, also known as Medigap plans, is a private insurance contract used with Medicare.
Original Medicare covers up to 80 percent of diagnostic exams like this one. You must pay the cost that Medicare doesn’t pay unless you’re already met the annual deductible.
Medicare supplement insurance may lower the amount you owe out-of-pocket for this test, depending on the specific policy and the coverage it affords.
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What’s an MRI?
“MRI” refers to the magnetic resonance imaging scan. Unlike a CT scan (using X-rays), the MRI uses magnetic fields and radio waves to make an image of your body’s bones and internal tissues.
The scan is used to aid the physician in diagnosing and creating a treatment plan for many ailments, including spinal cord injury, heart conditions, brain injury, bone and tissue damage, Alzheimer’s disease, and many other health problems.
When the doctor orders a magnetic resonance imaging scan, they want to confirm a diagnosis or collect more information about the root cause of your symptoms.
You might need to have multiple body parts scanned in an MRI. This is called an extremities scan. If a larger area of the body must be scanned, the doctor orders a closed scan.
Both types of tests require you to remain still for at least 45 minutes as the magnetic-charged field and radio waves create images of your body. This test is considered a non-invasive and low-risk procedure.
Medicare Treatment Costs
Medicare is a great boon to seniors. Original Medicare covers up to 80 percent of the prescribed treatment when the ordering physician and the facility at which it is performed accept Medicare.
Alternative options, including Medicare Advantage (Medicare Part C) and Medigap plans, can lower diagnostic costs even more.
Ask your doctor about any treatment concerns. If you’re concerned about the cost of a test, ask the provider or facility to provide a treatment estimate based on your Medicare, Advantage, and Medigap insurance coverage.
FAQ:
Does Medicare Cover MRI?
A: Yes, Medicare typically covers magnetic resonance imaging (MRI) scans when deemed medically necessary by a healthcare provider. Coverage falls under Medicare Part B for outpatient services, with beneficiaries responsible for 20% of the Medicare-approved amount. Prior authorization may be required in some cases, and coverage details can vary depending on the specific Medicare plan.
