What to Know About Medicare and MRI Cost

• Magnetic resonance imaging (MRI) is a non-invasive imaging technique used in diagnosing certain conditions as well as medical research. 

• MRI scans are covered by Medicare. Medicare plans cover 80% of MRI costs, with beneficiaries expected to pay the remaining 20% unless their yearly deductible has already been met.

• Costs may be lower for those with a Medicare Advantage plan or Medicare supplement plan. Beneficiaries will need to contact their insurance provider directly to confirm. 

• Medicare beneficiaries should always check with their health care provider and insurance company to confirm costs prior to diagnostic tests.

MRIs are non-invasive, effective screening procedures that can help diagnose many medical conditions. They also come with a significant cost, which may lead Medicare beneficiaries to ask: Does Medicare cover MRI scans?

In most cases, Original Medicare will cover the majority of costs associated with receiving an MRI when a doctor recommends this treatment or it’s required as part of a hospital stay. Medigap policies or having a Medicare Advantage plan may help cut costs even more. That said, overall MRI costs will vary based on the individual’s specific health care plan(s).

This article will explain everything Medicare beneficiaries need to know about how MRI scans work under the federal Medicare program, including average MRI costs and more.

An MRI is a non-invasive imaging technique that uses a strong magnetic field, radio waves, and a computer to capture detailed images of organs and tissues from inside the body. MRI stands for magnetic resonance imaging. MRIs use a machine, known as an MRI machine to perform the MRI scan.

What MRIs Detect

MRI scans play a crucial role in diagnosing a number of injuries and health conditions. These scans can detect health issues in various parts of the body, including:

• Internal organs like the brain (including brain stem)
• Nerves
• Muscles
• Ligaments
• Tendons

Since their invention in 1977, MRIs have become one of the most valuable diagnostic tools available, revolutionizing modern medicine.

Original Medicare covers various diagnostic tests done in hospital outpatient departments and other healthcare settings under Medicare Part B, Medicare’s medical insurance. Medicare Part B covers all necessary outpatient services which includes MRI scans, CT scans, EKGs, and other diagnostic non-laboratory tests. 
 

Criteria for Medicare Coverage

That said, some criteria must be met in order for Medicare to cover procedure costs and physician fees associated with getting a MRI. Some such criteria include:

• A doctor who accepts Medicare has ordered the scan
• The MRI is performed at a Medicare-approved hospital or facility
• The test must be deemed medically necessary and appropriate for the condition being evaluated
• Both the doctor and testing facility must accept Medicare assignment

As well, Medicare Part A, Medicare’s hospital insurance, may also provide MRI scan coverage if the test is ordered during hospitalization.

What Is The Average Cost Of An MRI?

On average, an MRI will cost around $1,119 in the United States for those without health insurance.

When it comes to Medicare coverage, however, Medicare generally pays for 80 percent of the Medicare-approved amount. The out of pocket expenses for the patient is the remaining 20 percent. The total costs will depend on where the MRI is performed, meaning whether it is outpatient or in-patient.

For example, MRI scans done in ambulatory surgical centers cost Medicare beneficiaries around $8.00. For an outpatient MRI scan, the cost averages around $16.00 for Medicare beneficiaries. 

The cost can also vary depending on geographic location, plan provider, and if more than one doctor is required for the MRI testing. Most Medicare and Medigap plans also require the MRI to be medically necessary for a specific medical condition, not based on personal decisions, which is sometimes referred to as an unlisted magnetic resonance procedure.

Note: These cost estimates are based on facility and doctor fees, but additional costs may be involved. Medicare beneficiaries should consult their doctor or insurance company to confirm coverage. This checklist of questions and considerations is a helpful resource.

Medicare Advantage plans, also known as MA plans or Medicare Part C, are Medicare plans offered via private insurance companies. These insurance companies are Medicare-approved.

A Medicare Advantage plan has the same covered services and cost sharing model as Original Medicare. MA plans also have additional benefits such as prescription drug coverage, dental coverage, and more. This means that beneficiaries with an MA plan may have a lower MRI cost. They will need to confirm coverage through a licensed insurance agent.

Note: Learn more about Medicare Advantage plans at this resource.

Medicare supplement insurance plans, also known as MedSupp or Medigap, are supplemental insurance policies that ​“fill in the gaps” of Original Medicare. Since these plans are in addition to Original Medicare, beneficiaries should expect their Medicare plan to still cover 80 percent of MRI costs, with their financial responsibility being 20 percent, unless they’ve already met their yearly deductible.

As well, Medigap policies may reduce out-of-pocket costs. However, this is all dependent on the specific plan and insurance company.

At times, prescription drugs may be needed to undergo an MRI scan. For example, if a beneficiary is anxious about going in a closed MRI machine, a doctor or other health care provider may order anti-anxiety medication. Under Medicare Part B, these medications are not covered. That said, Medicare Part D, which is Medicare’s prescription drug coverage, would cover it. Patients may also purchase a standalone prescription drug plan to assist them with medication coverage while on Medicare.