If you’re presenting a group of symptoms, not knowing the overall cause can be concerning to say the least. Whether it’s pain, a cough, or dizziness, it could point to something more serious. For these reasons, your doctor may order a diagnostic scan to look inside to see what could be wrong. But without insurance coverage, you could owe a lot of money out of pocket, especially if you have to get multiple scans. Luckily, there is help out there for Medicare beneficiaries.
Let’s explore the types of scans you may encounter and how Medicare covers them.
Before we look into costs and coverages, we should talk about the scans you may encounter and how they differ. These can influence how much you’ll pay out of pocket, as well as the procedure to acquire the scan. Some of these may be familiar to you.
X-Ray — X-radiation utilizes electromagnetic waves to create a representation of inside your body in shades of black and white. Something that absorbs more waves appears whiter, like bones. Fluids and organs appear as a shade of grey, while air often appears black. X-rays are useful to show fractures and tears, fluid buildup and pneumonia, or even tumors that may be cancerous. They are one of the oldest diagnostic scans, having been discovered in the late 1800s.
MRIs — Magnetic resonance imaging uses strong magnetic fields, radio waves, and computer imaging to picture the inside of your body in great detail. Unlike x-rays and CT scans, MRIs don’t use radiation. MRIs can scan for a wide range of concerns, such as issues in the brain and nervous system, tumors and cysts throughout the body, and even heart problems. This makes them highly useful diagnostic tools.
As you can see, each scan is highly useful in its own way, but there is a lot of overlap between the different types. If you’re confused as to why your doctor is ordering a specific scan, feel free to discuss it with them, as their reasoning can tell you a lot about your health.
Original Medicare places diagnostic scans under the category of diagnostic non-laboratory tests, along with EKGs and other diagnostic tests that health care professionals can perform without needing to send the results to a specialized facility. Generally, Medicare Part B helps cover these scans, so long as you’ve met your Part B deductible. If you’ve met the deductible, Medicare will pay for 80 percent of the approved costs. If you’re receiving the scan in a hospital outpatient setting, like if you’re observation status, you’ll also owe a copayment. Of course, to receive coverage, the health care facility you receive the scan from must also accept Medicare assignment.
You’ll have some out-of-pocket costs if you receive a diagnostic scan. Generally, if you’ve reached the Part B deductible ($203 in 2021), you’ll pay 20 percent of the Medicare-approved amount. Prices may vary based on your health care provider and location, but you can get an idea of what to expect by national averages.
Without health insurance, you can expect an x-ray to cost somewhere between $100 to $1,000, with the national average at around $260 to $460. If we say those are the Medicare-approved amounts and take 20 percent of each of those figures, you could expect to pay between $52 and $92 for the average x-ray. MRIs will generally cost between $400 and $3,500, depending on the procedure and body part scanned. Again, saying those are the Medicare-approved amounts, you’d be left with paying between $80 and $700 per scan. CT scans vary even more, ranging from $270 to $5,000 depending on the area, facility, and other factors. This means you may have out-of-pocket costs running from $54 to $1,000. Finally, PET scans are likely to be the most expensive of the scans, with prices based on similar factors to the other scans (location, setting, facility, etc.). You can usually expect these scans to cost somewhere between $1,250 and $9,225, with your out-of-pocket costs ending up being roughly $250 and $1,845.
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Whenever you’re experiencing symptoms, but don’t know what is causing them, it can be worrisome. The unknown is scary. Additionally, the processes through which doctors can figure out your diagnosis can be expensive, especially if you need multiple tests or scans. Thankfully, by working with your doctor, Medicare can help cover many of these scans and make a big difference in your health care experience!