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Be Proactive - Get Screened for Breast Cancer

Even with all the gains the medical profession has made, the battle between women and breast cancer continues.

That’s why the month of October is so important, as it is designated Breast Cancer Awareness Month.

According to the Centers for Medicare & Medicaid Services (CMS.gov), breast cancer is the second-most common form of cancer in women.

While breast cancer can strike women of any age, one of the most significant aspects of October’s awareness campaign is how seniors on Medicare are impacted.

Women – particularly seniors on Medicare – who are concerned after finding a mass or lump on their breasts are often afraid they cannot afford testing and/or treatment.

Medicare assures seniors that screening mammography to detect breast cancer for women – even those with no signs or symptoms of the disease – are covered for testing.

A patient does not need a physician’s referral to be tested. In addition, screening mammography is covered by Medicare Part B with no co-pay, co-insurance, or deductible, according to CMS.gov.

Medicare Part B also covers a clinical breast exam as part of the screening pelvic exam for beneficiaries who meet coverage criteria. Likewise, there is no co-pay, co-insurance, or deductible for such screening.

While Medicare covers screening mammography for women, it does not do so for men. However, diagnostic mammography for men and women can be covered by Medicare if certain coverage criteria are met.

Here are some tips for seniors on Medicare to increase their awareness of breast cancer and some steps to take if they have symptoms:


1 Women ages 65-74 should have breast cancer screenings every two years. Not only have screenings been shown to reduce deaths from breast cancer, but also Medicare Part B covers the cost of one mammogram screening each year.

According to the Centers for Disease Control’s “The State of Aging and Health in America,” almost half of all new cases and nearly two-thirds of deaths from breast cancer occur in women 65 years of age and older.
2 Male breast cancer is rare, making up less than one percent of all breast cancer cases. Still, male breast cancer is very real, and is detectable most often between the ages of 60 and 70. Male exams are also similar to female exams, calling for physicals, MRIs, ultrasound, and other necessary testing.
3 The National Cancer Institute’s Breast Cancer page is very descriptive and informative, particularly for seniors. It also covers what treatment, medications, and appointments are covered by Medicare.

The best place to start for suspected breast cancer is to undergo a mammogram. Here is helpful information about the whole mammogram process:


1 Medicare Part B covers advanced diagnostic mammograms when it is deemed medically necessary. While screening mammograms approved by a doctor or qualified health care provider are typically fully covered by Medicare, patients must pay 20 percent of the Medicare-approved amount for diagnostic mammograms (that is, the Part B deductible applies).
2 All necessary breast cancer treatment, including biopsies, is typically covered at least in part by Medicare Part A (for inpatients), Medicare Part B (for outpatients), and Medicare C (Medicare Advantage). To make sure you are covered, talk to your doctor or other health care provider. Other factors that may impact your Medicare coverage include other medical insurance you may have, how much a doctor charges, whether a doctor accepts assignment, the type of facility, and where you will get your test, item, or service performed.

A patient’s doctor or health care provider may recommend services more often than Medicare covers, or recommend services Medicare does not cover. If so, the patient may have to pay some or all of the costs. That’s why it’s always best for a patient to ask questions of a doctor or other health care professional so he or she can better understand why certain services are being recommended and whether Medicare will or will not pay for them.
3 Lastly, being diagnosed with breast cancer is not an immediate death sentence. With advancements in treatment, the number of breast cancer survivors continues to climb. There are millions of breast cancer survivors in the U.S., and their quality of life after treatment continues to improve as well.