Does Medicare Cover X-Rays?
Medicare covers X-rays when they are considered a medical necessity. The cause of the X-ray and the location you get the test will determine if it’s covered by Medicare Part A or Medicare Part B. Medicare Advantage (Part C) offers equivalent — and possibly more — coverage for X-rays, too.
Medicare will likely cover the test if your doctor orders a diagnostic X-ray, meaning it’s used to help form a diagnosis. However, any X-ray not deemed medically necessary will likely have to come out of pocket.
Table of Contents
When Are X-Rays Necessary?
An X-ray is a test that uses radiation to examine the inside of the body. For Medicare to cover an X-ray, it must be considered medically necessary. This means the X-ray is needed to aid a medical provider to treat or determine an injury or illness. There are many times when you may need a diagnostic X-ray, but some common instances include:
- Diagnose illnesses: It may be necessary to look at lungs, kidneys, or other organs for indications of diseases.
- Detect injuries: This test can be used to look for fractures, dislocations, and other bone injuries.
- Identify abnormalities: X-rays can scan the body for abnormalities such as tumors, cancer, and calcifications
- Scan for foreign objects: If a foreign object is lodged within the body, an X-ray may be used to help detect it and assess the best removal method.
- Mammograms: X-rays are used to examine the breast to detect signs of breast cancer and diseases.
Understanding Medicare’s Coverage of X-Rays
When it comes to Medicare, there are several parts of coverage to understand. Knowing how each part works will help you ensure your X-rays are covered.
Eligibility
In order for Medicare to cover an X-ray, the service must be considered medically necessary. This means that a medical provider or physician will use the test to help them access and treat an illness or injury.
Medicare Part A Coverage
Medicare Part A is also referred to as “hospital coverage.” It covers inpatient services such as hospitals, hospices, skilled nursing facilities, and home health care. This part of Medicare would cover X-rays performed on an inpatient basis.
For example, if you are admitted to the hospital for pneumonia, and the doctor orders an X-ray during your stay, Medicare Part A would cover that service.
Medicare Part B Coverage
Medicare Part B is also referred to as “health insurance.” It covers outpatient services such as doctor visits, diagnostic testing, outpatient procedures, and medical equipment. This part of Medicare would cover X-rays performed on an outpatient basis.
For example, if you break your foot and your doctor orders an X-ray to look for fractures, Medicare Part B would cover that service.
Medigap Coverage
A Medigap Policy is an optional plan that helps Medicare recipients cover gaps in their Medicare Part A and B coverage. These plans help reduce out-of-pocket costs by covering expenses such as the Part A deductible and Part B copays and coinsurance.
The Medigap plan you have will determine if X-rays would be covered. Review your Medigap plan-specific coverage details.
Coverage Limitations
Although Medicare will likely cover a medically needed X-ray, there are some limitations.
- Chiropractic services: Medicare will not cover X-rays ordered or needed for chiropractic services. Those would be paid out of pocket.
- Dental service: Original Medicare does not offer coverage for dental services, meaning that dental and orthodontic X-rays are not covered. Medicare Advantage may offer this coverage.
- Mammogram limitations: Medicare beneficiaries are limited to one mammogram scan per year.
How Does Medicare Advantage Cover X-Rays?
A Medicare Advantage Plan is coverage that you can choose in lieu of Original Medicare. These plans are sold and administered by private companies, but they must follow guidelines set forth by Medicare. Advantage Plans must offer the same coverage that Medicare Part A and B offer, and most of these plans include additional services such as dental and vision.
The Medicare Advantage Plan must cover an X-ray if considered medically necessary. However, the deductible and copay may be more or less than Medicare. It is also important to note that Medicare Advantage Plans are often subject to networks, which may require you to see a specific provider for the service to be covered.
How Much Do X-Rays Cost With Medicare?
The cost for an X-ray is around $279. However, that price can vary depending on the type of X-ray needed and the area that you live in. If you do not have insurance, you may have to pay the total amount out of pocket.
The service may be subject to your deductible and coinsurance amounts if you have Medicare. For Medicare Part A, a $1,600 per benefit period deductible must be paid before Medicare covers services. A benefit period refers to each hospital stay or qualifying event.
With Medicare Part B, there is a $226 annual deductible. Once that deductible is met, there is a 20% coinsurance. This means that Medicare would cover 80% of the X-ray cost, and you would cover the remaining 20%. An example of these costs is found in the table below.
X-Ray Cost | What Medicare Covers | Your Total Cost |
|---|---|---|
$279 | 80% of the X-ray: $223.20 | 20% of the X-ray: $55.80 |
If you have a Medigap Policy, this plan may pick up the out-of-pocket costs left from Part A and B, such as the deductibles and coinsurance amounts.
Medicare Advantage Costs
If you have a Medicare Advantage Plan instead of Original Medicare, the X-ray cost would depend on your enrolled plan. Certain plans may have high deductibles, which may have to be met before Medicare covers any portion of the X-ray. Reviewing your specific plan with your insurance provider before scheduling the service is essential.
Does Medicare Cover Imaging Tests?
There may be a time when an imaging test other than an X-ray is needed to help your doctor diagnose or treat you. If this is the case, knowing what Medicare will cover is important. The following tests are covered if they are deemed medically necessary:
- CT scan: Computerized tomography, CT scans, are scans that use a combination of X-rays and computer technology. These scans are used to get a clear image of the inside of your body to identify illnesses and injuries.
- MRI: Magnetic resonance image, MRI, is a scan that uses magnets to get a more detailed look into the body. These tests are often used to detect injuries and illnesses that an X-ray or CT scan cannot detect.
- PET scan: Positron emission tomography, PET, uses a radioactive drug, known as a tracer, that is injected into the patient’s veins. The PET machine then scans for the tracer and gives an in-depth look into the tissues and organs of the body. PET scans are used to look for illnesses and abnormalities in organs, such as cancer or brain injuries.
All in All
If you have Medicare, it is likely that an X-ray will be covered. However, it is important to know the ins and outs of your coverage before you schedule a test. For Medicare Part A or Part B to cover the test, it must be considered medically necessary. The X-ray may also be subject to your deductible and coinsurance amounts.
It is essential to review your plan before scheduling the test to see what your total out-of-pocket costs will be.