For most people with health insurance, a routine screening mammogram costs nothing. But many patients are surprised by a bill when they’re called back for more pictures or an ultrasound. The good news is that a federal update in effect for many plans in 2026 closes much of that gap. Here’s when a mammogram is free, when you might pay and how to check before your appointment.
Key takeaways
- Under the Affordable Care Act (ACA), most private health plans must cover screening mammograms for women 40 and older with no copay, coinsurance or deductible, when you use an in-network provider.
- Starting with plan years that begin in 2026, most private plans must also cover follow-up imaging and pathology needed to complete the screening process, such as more mammogram views, ultrasound, MRI or a biopsy, with no cost sharing.
- Medicare covers a screening mammogram every 12 months from age 40 at no cost if your provider accepts assignment. Diagnostic mammograms are subject to the Part B deductible and 20% coinsurance.
- Mammograms to check a symptom, such as a lump, are diagnostic and may come with costs.
- Grandfathered plans and out-of-network providers may not follow these rules.
Screening vs. diagnostic mammograms
The difference between these two is the main reason people get unexpected bills.
| Screening mammogram | Diagnostic mammogram | |
|---|---|---|
| Why it’s done | Routine check when you have no symptoms | To look at a symptom, such as a lump or nipple discharge, or to follow up an abnormal screening result |
| Typical cost with most private plans | $0 in network | Historically could include copays or deductible; since 2026, follow-up after an abnormal screening is generally $0 in network under most private plans |
| Typical cost with Medicare | $0 if your provider accepts assignment | 20% after the Part B deductible |
If you have a symptom, tell your doctor. A diagnostic exam may be the right test even if it costs more. Don’t skip it because of cost; ask about the price and your options instead.
What changed in 2026
In December 2024, the Health Resources and Services Administration (HRSA) updated its Women’s Preventive Services Guidelines. The updated breast cancer screening guideline recommends that when additional imaging or pathology is needed after a screening mammogram, these services are part of completing the screening process.
What that means for you:
- Non-grandfathered private health plans must cover these follow-up services without cost sharing when you use in-network providers.
- This includes additional mammogram views, breast ultrasound, breast MRI and biopsy, when they’re needed to complete the screening.
- For calendar-year plans, the change took effect on January 1, 2026.
- Plans must also cover patient navigation: personal help to guide you through screening and follow-up, such as scheduling, education and referrals.
- High-deductible plans must follow the rule too, and it doesn’t affect your ability to contribute to an HSA.
If your plan year starts mid-year, the change applies from your first plan year that begins after the effective date. Check with your insurer.
How often screening is covered
Under the HRSA guidelines, private plans cover screening mammograms for average-risk women at least every other year and as often as once a year, starting between ages 40 and 50. The U.S. Preventive Services Task Force (USPSTF) recommends screening every two years for women ages 40 to 74.
Medical groups don’t all agree on how often to screen or when to stop, and people at higher risk may need a different plan. Talk with your doctor about what’s right for you.
Medicare
Medicare Part B covers:
- One baseline mammogram between ages 35 and 39.
- A screening mammogram every 12 months from age 40.
- Both cost nothing if your provider accepts assignment.
- Diagnostic mammograms when medically necessary, including more than once a year. You pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026).
- Breast ultrasound when medically necessary and ordered by your provider.
Don’t assume the 2026 private-plan update applies to Medicare. If you have a Medicare Advantage plan, check its rules for follow-up imaging.
Medicaid
Medicaid covers screening mammograms in all states, and preventive services usually have little or no cost sharing. Rules for follow-up imaging vary by state. Your state Medicaid office or health plan can tell you what applies.
When you might still pay
- Grandfathered plans that existed before the ACA and haven’t changed much don’t have to follow the preventive care rules.
- Out-of-network providers aren’t covered by the no-cost rules.
- Diagnostic mammograms for symptoms, which aren’t part of screening.
- Some short-term or limited plans that don’t follow ACA rules.
- 3D mammography (tomosynthesis): many plans cover it, but some may charge extra. Ask first.
- Supplemental screening for dense breasts if you don’t have an abnormal mammogram: coverage depends on your plan and state law.
How to avoid a surprise bill
- Confirm the imaging center and radiologist are in your network.
- Ask whether your exam will be billed as screening or diagnostic.
- If you’re called back, ask whether the follow-up is covered as part of screening under your 2026 plan.
- Ask your insurer about coverage for 3D mammography and supplemental imaging.
- If you get a bill for something you think should be free, call your insurer and ask them to review the claim. You can appeal if needed.
Frequently asked questions
Is a 3D mammogram free with insurance? Often, but not always. Many plans cover 3D mammography as screening. Check with your insurer.
Is a breast ultrasound after a mammogram free? Under most private plans in 2026, yes, if it’s needed to complete screening after an abnormal mammogram and you use in-network providers. Under Medicare, it’s subject to the deductible and coinsurance.
Why did I get a bill for my screening mammogram? Common reasons include an out-of-network provider, a grandfathered plan, or billing as diagnostic instead of screening. Call your insurer and the imaging center to check.
Do I need a referral for a screening mammogram? Many imaging centers accept self-referral for screening, but some plans require a doctor’s order. Check before you book.
Sources
- Medicare.gov: Mammograms.
- International Foundation of Employee Benefit Plans (IFEBP): What group health plans should know about additional breast cancer screening coverage in 2026 (December 2025).
- DenseBreast-info: Updated federal breast screening recommendations (February 2025).
- Health Resources and Services Administration (HRSA): Women’s Preventive Services Guidelines.
- U.S. Preventive Services Task Force (USPSTF): Breast Cancer Screening recommendation (2024).
This article is for general information only and isn’t medical or insurance advice. Coverage rules vary by plan. Talk to your doctor about screening and check with your insurer about costs.