Does Medicare Cover an MRI?

Magnetic resonance imaging, or MRI, is a test that doctors can use to diagnose illnesses, injuries and other medical conditions. An MRI uses powerful magnets and computers to produce more in-depth images than other CT scans and X-rays. Best of all, MRIs are non-invasive and can be a critical tool in the fight against diseases like cancer.

If you’re on Medicare and need an MRI, you probably have more questions. For example, how much does an MRI scan cost? How does Medicare cover MRI, and are all forms of MRI covered by Medicare? To help find the answers you’re looking for, here’s an in-depth look at MRIs and Medicare.

Yes, if you need an MRI of your brain or brain stem, Medicare can help cover your MRI brain scans. An MRI can be a valuable tool in diagnosing issues as it creates in-depth, three-dimensional models of your internal organs. In addition, MRI scans allow doctors to spot abnormalities or health conditions without surgery, which can be especially helpful when evaluating the brain and brainstem.

Here are a few of the health conditions that may require an MRI brain scan:

• Cysts
• Aneurysm
• Tumors
• Inflammation
• Traumatic brain injury
• Hydrocephalus (fluid on the brain)
• Vascular issues
• Concussions

The answer is generally yes, as long as your service meets a few conditions. For example, an MRI scan is considered a covered medical service by Medicare. That means Medicare will partially pay for your MRI. How much will an MRI cost you? That depends on how you receive your MRI and what kind of Medicare you have. Here’s what we mean:

• If you have Original Medicare (Parts A and B) and receive an MRI while admitted to the hospital — also known as inpatient — Part A can cover your MRI scan cost.

• If you have Original Medicare (Parts A and B) and receive an MRI as an outpatient (and not while hospitalized), Part B will help pay for your MRI.

• If you have Medicare Advantage (Part C), you’ll receive at least the same coverage for MRI testing. However, part C is private insurance and may offer different costs than Parts A and B.

How much is an MRI scan?

MRI testing typically costs thousands of dollars without health insurance, giving Medicare beneficiaries a hugely valuable benefit as MRIs are covered similarly to other covered medical procedures. In addition, Medicare beneficiaries often pay a fraction of what uncovered services cost.

• If you receive an outpatient MRI, Medicare Part B generally pays for 80% of your testing. You’ll pay the remaining 20% after you’ve paid your Part B deductible. In 2022, the average cost of a standard MRI for Medicare beneficiaries was $8 when performed in a stand-alone medical facility ($16 in hospital outpatient departments). In 2022, brain scan MRIs cost $59 in a separate facility and $95 in hospital outpatient departments.

• If you receive an MRI as an inpatient, Medicare can pay 100% of your costs if it’s performed within the first 60 days. If you receive your MRI after Day 60, Medicare can cover your testing, but only if you pay your daily costs.

Several other factors can affect your MRI scan cost. For example, you may pay more if your testing needs more than one doctor or if you need a contrast dye to sharpen your imaging results. If you’re budgeting for your service and want to know exactly how much your MRI will cost, talk to your doctor. You can discuss where you receive the MRI and other details that will impact how much you’ll pay for your MRI.

To help with out-of-pocket costs like these, many Medicare beneficiaries also often enroll in Medicare Supplement Insurance (Medigap). Medigap plans are sold by private health insurance companies and can help cover premiums, deductibles, coinsurance, and copayments. Others enroll in Medicare Advantage (Part C). Medicare Advantage replaces Original Medicare (Parts A and B) but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional dental, hearing, vision and prescription drug coverage. It also may charge different amounts for services like MRIs.

Why would a doctor order an MRI scan?

Magnetic resonance imaging produces powerful images that allow doctors to see even minor abnormalities without the need for surgery. While we’ve discussed MRIs that scan the brain, magnetic resonance can be beneficial to evaluate and diagnose other parts of the body. For example, with the help of MRI, doctors can spot ligament and muscle tears, strains, cysts, swelling, internal bleeding, tumors and more.

No. MRI and CT scans are two different tests. Unlike an MRI, CT scans use radiation to create images of bones, tissues and other areas below your skin. However, like an MRI, CT scans can diagnose health issues in a non-invasive manner. Short for Computed Tomography, CT scans produce better images than X-rays. Both CT scans and MRIs detect cancer, though MRIs often can see forms of cancerous tissue that CT scans may miss.

Yes. For Medicare to cover an MRI, you’ll need authorization. Here’s how it works:

• Your magnetic resonance imaging (MRI) must be deemed medically necessary by a doctor or provider that accepts Medicare.

• The provider that performs your MRI must accept Medicare.

• If your plan uses provider networks, the specialist that performs your MRI must be in-network. If not, you may have to pay for more, or all, of your MRI than if an in-network provider performed it.

MRIs are an incredibly effective tool for spotting and preventing health issues. They give doctors a surprisingly clear view of the human body without the need for invasive surgeries, making them especially helpful when examining sensitive areas like the brain. If you have specific questions about MRIs and your health, talk to your doctor. If you need more information on how MRIs fit with your Medicare, give GoHealth a call. Our licensed insurance agents will discuss your details and make sure your current plan has the coverage you need. If not, they’ll find one that does.