October is Breast Cancer Awareness Month, a time dedicated to raising awareness about breast cancer and the importance of early detection. For Medicare beneficiaries, understanding available preventive services can make a significant difference in maintaining health and well-being.

Breast Cancer Screening and Medicare Coverage

Medicare provides coverage for essential preventive services, including breast cancer screenings. These services help detect potential issues early when treatment is most effective. Here’s what Medicare offers:

1. Mammograms

Medicare Part B covers screening mammograms for women aged 40 and older once every 12 months. Medicare also covers diagnostic mammograms, when necessary, which can be done more frequently if recommended by a doctor.

Cost: Screening mammograms are fully covered by Medicare, meaning there’s no cost to the beneficiary if the provider accepts Medicare. For diagnostic mammograms, you may be required to pay 20% of the Medicare-approved amount after meeting your Part B deductible.

2. Clinical Breast Exams

Although not as common, some healthcare providers may still recommend clinical breast exams. While Medicare doesn’t specifically cover this service, it’s important to discuss with your doctor whether this type of exam should be included in your preventive care.

Medicare Advantage Plans and Additional Benefits

If you are enrolled in a Medicare Advantage plan (Part C), you still have access to the same preventive services as those covered under Original Medicare. However, your plan may offer additional benefits such as:

Wellness Programs: Some Medicare Advantage plans include programs focused on health screenings and education.
Reduced Copayments: Depending on your plan, you may have lower out-of-pocket costs for certain diagnostic services or treatments.
Telehealth Services: Some plans offer telehealth visits, allowing you to consult with a healthcare provider from the comfort of your home, which can be helpful in managing ongoing health concerns.

Genetic Testing for Breast Cancer

Medicare may cover genetic testing (BRCA1 and BRCA2) for individuals with a personal or family history of breast cancer that puts them at a higher risk. Discuss with your healthcare provider to determine if this option is appropriate for you.

Take Action: Early Detection Saves Lives

Being proactive about your health is crucial. Taking advantage of Medicare’s preventive services can help you catch potential issues early and improve outcomes.

If you have any questions about your Medicare coverage or preventive care, now is a great time to schedule a benefits review with us. The Medicare Annual Enrollment Period (AEP) runs from October 15th to December 7th, allowing you to make changes to your 2025 coverage.