Does Medicare Cover MRIs?

Medicare covers MRI scans when they’re considered medically necessary to diagnose a health condition. Medicare Part A helps pay for the MRIs ordered during a covered inpatient hospital stay. In contrast, Medicare Part B pays for outpatient scans at hospitals or other healthcare facilities. Further, Medicare Advantage offers this same coverage, though the eligibility requirements and associated coverage will vary by plan.

What Is an MRI?

An MRI (Magnetic Resonance Imaging) is a widely used medical imaging test that doctors use to diagnose health conditions or monitor how well a treatment for a medical condition is working.

MRI machines use powerful magnets and radio waves to take detailed pictures of the inside of the body, such as bones or soft tissue similar to x-rays. In some cases, MRI images are clearer than those produced by X-rays or CT (computerized tomography) scans.

People with Medicare get MRI scans to diagnose various health conditions. The MRI scan test is used to identify everything from pinched nerves and joint problems to heart disease and bone tumors and has Medicare coverage.

How Does Medicare Cover an MRI?

Medicare covers MRIs through both Part A (Hospital Insurance) and Part B (Medical Insurance). Part A helps pay for diagnostic MRIs a doctor orders during a covered inpatient hospital stay. In contrast, Part B covers the diagnostic MRIs that beneficiaries receive on an outpatient basis.

In both cases, the MRI must be medically necessary and performed in a Medicare-approved hospital or facility. Medicare does not cover MRIs if the procedure may be harmful, such as for beneficiaries who have claustrophobia, are pregnant, or have pacemakers and metallic clips.

Eligibility

Americans generally become eligible for Medicare when they turn 65. Some people become eligible for Medicare coverage before 65 because they have specific disabilities or End-Stage Renal Disease.

Medicare covers beneficiaries’ MRI scans when specific criteria are met. The main eligibility rules for Medicare MRI coverage include the following:

A physician who accepts Medicare ordered the MRI.
The MRI is reasonable and necessary for the beneficiary’s health condition.
The physician consulted a clinical decision support mechanism to confirm an MRI is the most appropriate test.
The test is performed at a hospital or facility that accepts Medicare.
The beneficiary has met their deductible.

How Often Does Medicare Cover MRIs?

Medicare does not set annual or lifetime limits on how many MRI scans a Medicare beneficiary can receive. It covers MRIs each time a Medicare-approved doctor orders them, so long as the scans are still reasonable and medically necessary.

Doctors may recommend repeated MRIs to keep an eye on certain health conditions. For example, Medicare guidelines note that MRIs are covered to monitor bone tumors or the death of bone tissue due to a lack of blood supply.

How Does Medicare Advantage Cover MRIs?

Medicare Advantage plans are a private, Medicare-approved alternative to the traditional Medicare program. Each Medicare advantage plan is required to cover the same Part A and Part B benefits as Original Medicare. Since Original Medicare covers the cost of MRIs as diagnostic non-laboratory tests, the same coverage is available through Medicare Advantage.

While each Medicare Advantage plan offers coverage for medically necessary MRIs, plans are allowed to set additional criteria for getting an MRI covered. People in Medicare Advantage typically need to choose doctors and MRI providers in their plan’s network. Some Medicare coverage plans offer coverage for out-of-network MRIs at an increased cost.

For details about a plan’s Medicare MRI coverage, check its policy documents. The Summary of Benefits provides an easy-to-understand overview of covered services and costs, and the Evidence of Coverage offers more detailed information. The plan’s Provider Directory lists the doctors and MRI providers that belong to the network.

How Does Medicare Supplement Insurance (Medigap) Cover MRIs?

Medicare Supplement Insurance is optional insurance coverage for people with Original Medicare. It helps beneficiaries pay out-of-pocket costs, such as deductibles, coinsurance, and copayments.

There are ten standardized Medigap plans identified with the letters A, B, C, D, F, G, K, L, M, and N, and each covers a different set of benefits.

Depending on the plan, beneficiaries may get help paying for the following MRI-related costs:

Part A deductible: $1,600 for each inpatient hospital benefit period. With the exception of Plan A, every Medigap plan helps cover the Part A deductible.
Part A coinsurance: $400 per day for days 61 to 90 of a hospital stay. Each of the ten plans covers the entire cost.
Part B deductible: $226 per year. Only Plan C and Plan F cover this deductible, and they’re available to people eligible for Medicare before Jan. 1, 2020.
Part B coinsurance: 20% of the Medicare-approved amount for outpatient MRIs. Each of the ten standardized plans covers some or all of the coinsurance.

How Much Would an MRI Cost With Medicare?

The average cost of an MRI varies depending on several factors, including the part of the body being scanned, the type of facility that performs the test, and whether or not contrast dye is used. Medicare MRI coverage helps make the cost more affordable.

An MRI is an expensive test without insurance. Nationally, the average hospital cash price for an MRI scan of the lower spine is $1,625. People with Medicare pay much less to cover MRI scans: The average out-of-pocket cost for the same test in a hospital outpatient department was just $61 in 2022.

The average MRI scan cost with insurance varies in Medicare Advantage Plans.

For in-network MRIs, plan members typically pay a copay ranging from $150 to $250. Some plans cover out-of-network MRIs, though members typically pay more. Check the plan’s Summary of Benefits for details.

MRIs vs. Other Imaging Scans

MRIs are not the only type of diagnostic scan covered by Medicare. The table below explains Medicare’s coverage of other outpatient imaging tests.

	Medicare Coverage	Coverage Cadence	Imaging Process
MRI	Medicare pays 80% of the Medicare-approved amount	When medically necessary for diagnosis	15-60 minutes; lie still inside an MRI machine
Computed (Axial) Tomography (CT and/or CAT scan)	Medicare pays 80% of the Medicare-approved amount	When medically necessary for diagnosis	10-30 minutes; scanned with CT machine
Electrocardiogram (EKG)	Medicare pays 80% of the Medicare-approved amount	When medically necessary for diagnosis	5-10 minutes; electrode placement; machine traces heart activity
Positron Emission Tomography (PET scan)	Medicare pays 80% of the Medicare-approved amount	When medically necessary for diagnosis	Two hours; injection of tracer; lie inside a PET scanner
X-ray	Medicare pays 80% of the Medicare-approved amount	When medically necessary for diagnosis	5-15 minutes; scanned with X-ray machine

How Each Imaging Scan Type Works

MRIs and other types of scans use different methods to create images. Here’s how the main Medicare-covered imaging scans work:

Magnetic Resonance Imaging (MRI): This procedure relies on strong magnets and radio waves to create images. During the test, patients lie still inside a large, tube-shaped machine.
Computerized Tomography (CT) Scan: This procedure takes a series of X-ray images. The images are combined with computer processing to create more detailed views than regular X-rays. During the test, patients lie on a narrow table that moves into a doughnut-shaped scanner.
Electrocardiogram (ECG or EKG): This test uses sensors on the skin to record the heart’s electrical signals. It does not take a picture of the heart; instead, the signals are displayed with wavy lines on paper.
Positron Emission Tomography (PET): This imaging test uses a radioactive tracer to find locations of disease. The tracer is injected into a vein; then the patient lies in a machine that looks like an MRI or CT scanner.
X-ray: This widely used imaging test that uses radiation to take pictures. The radiation painlessly passes through the body and records an image.

How to Ensure Your MRI Is Covered

Medicare covers a portion of MRI costs when the scan is medically necessary. Follow these simple steps to ensure Medicare will help pay for your MRI.

1. Get a Referral for Imaging

Medicare only covers MRIs when the test is ordered by a doctor who accepts Medicare. If you think you need an MRI or other diagnostic imaging test, see a doctor to ask for a referral.

2. Verify the Test Is Covered

Medicare requires doctors to consult with an electronic tool when ordering an MRI, and in some cases, doctors need to get prior authorization from Medicare or the Medicare Advantage plan. Talk to your doctor or plan to confirm that the MRI scan is a covered service.

3. Choose an In-network Facility, If Applicable

People with Medicare Advantage Plans are often required to get care from in-network providers to cover MRI scans. If your plan has network restrictions, check the Provider Directory to find an in-network MRI provider in your area.

4. Know How to Appeal

Beneficiaries have the right to appeal if Medicare or their Medicare Advantage Plan refuses to pay for their MRI as Medicare will cover MRI tests. Check the denial notice for details about how to start the appeals process.

Putting It All Together

Medicare covers MRIs and other non-laboratory diagnostic tests when they’re medically necessary to diagnose a health condition. The program helps pay for both inpatient and outpatient MRIs to ensure beneficiaries can access the care they need. With Medicare, the MRI scan cost with insurance can be a fraction of the cost without insurance.

While Medicare covers MRIs, these scans may not be appropriate for all beneficiaries. Doctors may recommend other Medicare-covered imaging tests for people with pacemakers or metallic implants or health conditions like claustrophobia.

Frequently Asked Questions

Medicare does not limit the number of MRI scans a beneficiary can receive. Both Original Medicare and Medicare Advantage continue to cover MRI tests, paying their portion of the costs of MRI scans as long as they’re reasonable and medically necessary.

It may depend on your doctor and how you get your Medicare benefits. With Original Medicare, doctors must consult a clinical decision support mechanism to ensure the MRI they’re ordering is appropriate. Doctors who order an unusual amount of MRIs may be required to get prior authorization from Medicare before a scan is covered.

Medicare Advantage Plans may require prior authorization for MRIs. The doctor ordering the MRI is responsible for getting this approval. If you’re in Medicare Advantage, check your plan’s coverage details to learn if prior authorization is needed.

The out-of-pocket cost for an MRI varies depending on many factors, including where the test is performed and Medicare plans such as whether you have Original Medicare or Medicare Advantage.

In Original Medicare, beneficiaries typically pay 20% of the Medicare-approved cost of an outpatient MRI. However, an additional copayment applies if the scan is performed in a hospital outpatient department. Medigap plans help cover these costs.

Out-of-pocket costs vary in Medicare Advantage. After meeting their plan’s deductible, beneficiaries pay anywhere from $150 to $250 for a covered MRI.

Medicare covers MRI scans performed in various healthcare settings as long as the facility accepts Medicare. It pays for MRI scans in hospitals when people are admitted as an inpatient or when they have an outpatient appointment. Medicare also covers outpatient MRIs performed outside the hospital, such as in ambulatory surgical centers or imaging clinics.

Medicare does not cover MRI scans without an order from a doctor or other healthcare provider. Beneficiaries who choose to have an MRI without a referral are responsible for the entire cost of the scan.

Medicare Coverage for MRI Scans: Coverage and Eligibility Criteria