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Monday, October 19, 2009 marilyn, Community Member, asks

Q: Medicare will now 'only' pay for a mamogram every 2 years? IS THIS TRUE?

October 19,2009


My friend went to her Gynocologist today. She was told that now (or maybe she misunderstood..maybe in the near future like beginning Jan. 2010) that Medicare will 'only' pay for a routine mamogram every 2 years, no more annually. I guess this probably will mean that all or many other health insurance plans will follow this course too. Is this right?


WHAT???? For years I have been going for 'routine' mamograms. This year, from a 'routine' mamogram, I discovered that I had Breast Cancer. It was only 1cm and had not spread to the lymph nodes. What if I had to have waited until 'next' year?


What in the world is going on? Who is 'fighting' for us women? First it was that Pap smears are 'not necessary' and will not be paid for every year and NOW THIS WITH MAMOGRAMS!




I don't have to worry about myself because i assume because of having breast cancer that I will have a mamogram paid for me thru Medicare, plus the fact, even if they won't pay, you can be certain that I will self pay.

My concern is about all other women, who will be told 'it isn't necessary to have it yearly' (as now I am being told about the Pap Smears by my Gyncologist)


Sheeshhhhhhhh...can anyone get anything straigh around it any wonder I don't trust the medical field at all.


How can anyone now say, 'yearly mamograms are not necessary' ?


My question: Is it true that Medicare now or in the near future will only pay for 'every two years' a mamogram?  My second question is: Is this ok with the Cancer Society and all others who are 'actively' fighting to 'conquere' Breast Cancer?

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Answers (1)
PJ Hamel, Health Guide
10/19/09 8:38pm

Marilyn, two issues:


First, here's what he American Cancer Society Web site says about Medicare coverage of mammograms:


"Mammogram screening is covered for all women with Medicare age 40 and older every 12 months. You can also get one baseline mammogram between ages 35 and 39. You pay 20% of the Medicare-approved amount with no Part B deductible. Medicare also covers new digital technologies for mammogram screenings. Medicare provides 80% coverage for a clinical breast exam once every 24 months, without Part B deductible.


"At this time, Medicare's cancer screening coverage information does not include MRI in addition to mammogram as a covered screening method for women who are at high risk for breast cancer. If you and your doctor agree that you are at high risk for breast cancer, you may be able to find out more by talking with your doctor's billing service about possible Medicare coverage for breast MRI."


Second issue: There's quite a bit of controversy within the medical community itself about the usefulness of yearly mammograms; studies show that overall, they identify more cancer earlier, but counterintuitively, don't significantly reduce the death rate from breast cancer. Studies also show that about 40% of identified breast cancers, if left untreated, would disappear on their own. So there are those who advocate mammograms as an elective screening, not a required good practice. I know, I know, I can hear you yelling! I probably had my life saved by a mammogram, so I'm one of the ones who it helped. But apparently many women go through unnecessary biopsies, pain/suffering/stress, due to diagnostic mammograms that mistakenly point to cancer.


Bottom line - there's no absolute right or wrong here. At least it looks like Medicare covers a mammogram every year though, if you decide to have one. Thanks for connecting here - PJH

marilyn, Community Member
10/19/09 9:17pm

thank you very much...although I will have to digest all this, but a  question arises here...this 'clinical breast exam every 24 months' ...It is not clear to me what you are referring to.


All I know is that this year I went for a mamogram and they did mention it was 'digitalize' (i believe they said or inferred that this was a 'new' system)


Let's say I did not have breast cancer ever diagnosed...I have Medicare and Part B. I am 69 years old. If, as always in the past,  I went for my yearly mamogram  with having no problems, I assume they would give me the 'digitalize' mamogram which I can take every year as you are saying.


PJ Hamel, Health Guide
10/19/09 9:21pm

Marilyn, a clinical breast exam just refers to the one you get from the doctor, where s/he physically feels all over your breasts. Seems funny that they'd fund that every 2 years, not every year - I'm not on Medicare yet, but do they pay for an annual physical? If so, I'd think the breast exam would be part of the physical... Digital mammograms are replacing the older film mammograms; that's probably what they were referring to. They're just easier to handle - the results can be transmitted immediately, via Internet, wherever they need to go. No more sedning films here, there, and everywhere... PJH

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By marilyn, Community Member— Last Modified: 12/22/10, First Published: 10/19/09