If you’re one of the 55 million Americans who receive Medicare benefits, chances are you’ll be covered when your doctor orders an MRI scan. Unfortunately, health care is complicated, and there are exceptions.
Even if your plan does cover the cost of an MRI, Medicare may not pay the whole bill. Depending on your unique case, you might have to pay a copay or a percentage of the cost (and negotiating a cash price may end up being even more affordable—but more on that later).
Talk to your health care provider to learn more about your specific situation. To get you started on the subject of Medicare and MRI scans, though, here are a few things you should know:
- Medicare Part B will only cover your MRI if it’s considered “medically necessary.” The government program has a pretty strict definition of the term “medically necessary.” It refers to “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine,” according to Medicare.gov.
Luckily, your doctor won’t order medical imaging unless there’s a good reason. That means if you have a referral to an imaging provider, that MRI probably meets Medicare’s definition of “medically necessary.”
- Medicare Part A might cover diagnostic imaging, but only as part of broader inpatient hospital care. While Part B of the plan helps pay for outpatient services, Medicare Part A is more concerned with inpatient stays at hospitals, skilled nursing facilities, and the like. As such, Part A will probably only cover a doctor-ordered MRI if the referral takes place while you’re in the hospital.
You might also have to meet your Part A deductible before the plan kicks in.
- The typical Medicare payment for patients enrolled in the original plan is 80 percent of the Medicare-approved price.Note that this may or may not be the actual fee your provider charges. The Centers for Medicare & Medicaid Services (CMS) work with the American Medical Association to establish what they consider a “fair” price for a given medical treatment. Individual providers are welcome to charge more or less than the CMS price—but Medicare will only pay for 80 percent of what they list on their books, not a percentage of the provider’s actual price tag.
- You must choose an imaging provider who accepts Medicare to receive the payment benefit. Not all diagnostic imaging facilities accept Medicare payments, so it’s important to find out what plans your provider will accept before scheduling your procedure. Your doctor may have a list of Medicare-approved imaging centers, or you could always call around yourself.
The other option is to look for facilities that offer low cash prices. Believe it or not, you might save more money bypassing Medicare altogether. BestPriceMRI.com has negotiated cash prices that can be even cheaper than the portion of the bill Medicare leaves the patient to cover.
To discuss low cash prices or to make an appointment, call BestPriceMRI.com at 888-322-7785 today.
“Diagnostic Tests.” Medicare. U.S. Centers for Medicare & Medicaid Services, n.d. Web. 21 July 2017.
“Total Number of Medicare Beneficiaries.” KFF. Kaiser Family Foundation, 2017. Web. 21 July 2017.
“What Part A Covers.” Medicare. U.S. Centers for Medicare & Medicaid Services, n.d. Web. 21 July 2017.