March 22nd 2024
By Ari Parker
Original Medicare and Medicare Advantage cover MRI scans, but costs differ between the insurance types. Learn how and what to expect for coverage in this article.
Magnetic Resonance Imaging (MRI) scans are important imaging devices that healthcare providers use to see internal parts of your body. You may need an MRI to diagnose brain and spinal cord issues, musculoskeletal conditions, and abnormal tissue behavior.
Thankfully, Medicare covers an MRI scan if your doctor orders one. In this post, we’ll explore what your out-of-pocket costs could be and special factors to keep in mind if you have a Medicare Advantage plan.
Original Medicare covers MRI scans. You'll most likely be responsible for 20% of the cost of the scan once you’ve met your deductible.
Medicare Advantage plans cover MRI scans, but your out-of-pocket costs can vary from one plan to another.
Either from watching TV shows or personal experience, you might be familiar with the cylindrical, tube-like magnet of an MRI machine. MRI uses strong magnetic fields and radio waves to create detailed images of the internal structures of your body.
Doctors generally use MRIs to see what’s going on with your organs and tissues and diagnose or rule out specific conditions. Unlike X-rays or CT scans, MRIs are safer to use repeatedly since they don’t use radiation.
Healthcare providers recommend MRIs for a variety of reasons, including:
Diagnosing medical conditions, like tumors, spinal cord injuries, strokes, arthritis, heart problems, and abdominal issues
Monitoring disease progression for cancer, multiple sclerosis, and other chronic conditions
Guiding surgeons by helping them learn the location of abnormalities
Assessing the severity of injuries after an accident by examining damage to soft tissue, muscles, nerves, and other internal materials
To prepare for an MRI, you’ll follow instructions that your doctor gives you. Most instructions include information about fasting, avoiding metal objects, and wearing clothing without metal accessories.
Medicare covers an MRI scan if your doctor says that it’s medically necessary to diagnose or manage a condition. Medicare considers MRIs to be “diagnostic non-laboratory” tests, which are tests that don’t require bodily fluids for examination.
When your doctor orders an MRI for you, they’ll likely refer you to an MRI facility. Make sure that you ask your provider to refer to an MRI facility that accepts Medicare.
Once you meet your Part B deductible, you’re responsible for 20% of the cost of an MRI scan. You’ll have to pay a hospital copayment if you receive the test at a hospital as an outpatient. If you want to avoid the hospital copay, ask your doctor to refer you to an outpatient MRI facility.
Yes, Medicare Advantage plans cover an MRI scan if your doctor recommends one for you. By law, Medicare Advantage plans must cover the same services as Original Medicare. However, you may experience certain setbacks with Medicare Advantage plans when receiving an MRI.
Many Medicare Advantage plans operate under network providers. If your doctor refers you to an MRI facility, check to make sure that they accept your insurance so you can use your coverage and save.
Medicare Advantage plans often require prior authorization for coverage. If denied, you can appeal the authorization decision. Otherwise, you’ll have to pay the full cost of the MRI.
Your out-of-pocket costs can vary. Medicare Advantage plans have varying out-of-pocket costs. Depending on your insurance, you could end up paying more than average for an MRI.
Thankfully, Medicare Advantage plans have annual limits on out-of-pocket costs. So, if your costs for healthcare are more expensive during a certain year, you won’t have to pay more once you’ve reached the limit.
The average cost of an MRI without insurance can range from $477 to $12,000. Your cost would depend on what you need scanned, the facility you go to, and additional materials needed for the MRI scan (like contrast dye).
If you have Original Medicare, the average out-of-pocket cost for an MRI is $60 for a standard outpatient visit and $94 for a hospital outpatient department visit.
Chapter can help you ensure that you understand your healthcare costs. If you need help anticipating your expenses with Medicare, an Advisor can guide you through your plan or find one that’s more affordable for you. Get started today with free, personalized advice by calling us at 855-900-2427 or scheduling a time to talk in advance.
