Does Medicaid Cover MRI Screenings?

In this article...
  • MRI scans are used to detect injuries and medical conditions in the clinical setting. Medicaid may cover some of the costs of this diagnostic procedure.

Magnetic resonance imaging (MRI) procedures are used to diagnose a range of medical conditions and to rule out others. The equipment used to perform MRI procedures is both costly and bulky, which limits the use of these machines outside the hospital or clinical environment. MRIs can be expensive for patients. Fortunately, both Medicare and Medicaid will often pay for as much as 80% of the overall cost of these diagnostic procedures. This will typically limit your out-of-pocket expenses to a considerable degree.

What Is an MRI?

An MRI uses magnets and radio waves to create an image of the inside of the body. It is primarily used to construct images of the soft tissues of the body and of the central nervous system. Unlike X-rays, MRIs don't require potentially harmful radiation to create images of the interior of the human body and to assist physicians in the diagnostic process. This makes them a valuable tool in identifying various problems and issues that cannot readily be seen from the outside. MRIs are classified by Medicaid and Medicare as diagnostic non-laboratory tests.

Why You Might Need an MRI

MRIs are used as diagnostic tools for a range of issues that include:

  • Potential brain or spinal cord injuries or anomalies
  • Abnormalities of the organs in your abdomen, including certain diseases and cancers
  • Tumors and cysts
  • Assessments for breast cancer in high-risk patients
  • Diseases of the heart or liver
  • Injuries to joints or soft tissues of the body

About 30 million MRI procedures are conducted each year in the United States. The detailed images produced by this technology are extremely useful in the clinical setting.

Does Medicaid Cover MRI Scans?

MRI scans may be covered at 80%, leaving you to pay the remaining 20% of the costs associated with this procedure. To qualify for Medicaid payment, however, the scans must meet three important criteria:

  • The test must have been ordered by a physician who accepts Medicaid and Medicare payments.
  • The MRI must be performed in a facility that also accepts payment from Medicaid and Medicare.
  • The MRI must be deemed necessary to diagnose your medical condition.

Because Medicaid coverage can vary from state to state, it is important to touch base with your Medicaid advisor to find out how much you will need to pay out-of-pocket for your MRI diagnostic scan. The 80% and 20% figures are based on Medicare-approved costs, which could potentially be lower than the cost assessed by your medical facility.

Medicare Coverage for MRI Scans

Under Original Medicare, which is defined as Medicare Part A and Part B, you will pay 20% of the cost of your MRI. Medicare will pick up the other 80%, which can significantly reduce your financial obligations for these treatments. If you are covered by Medigap or Medicare Advantage, your out-of-pocket costs may be even lower. These insurance options are sold by private insurers and offer gap coverage for the costs Medicare does not cover on your behalf.

It is important to note that you will also have to pay your Medicare Part B deductible before your benefits will be applied. In 2021, this amount adds up to $203 but may increase over time. For patients who had Original Medicare in 2021, the average cost paid out-of-pocket for an MRI was $99 in the hospital outpatient setting and $61 for procedures performed in an ambulatory surgery clinic. These costs were for a single MRI, facility costs and physician fees.

What Scans Does Medicare Cover?

Along with MRIs, Medicaid and Medicare cover other diagnostic non-laboratory tests.

  • X-rays are perhaps the best known type of scan. These diagnostic tools use radiation to create images of the bones, organs and tissues inside your body.
  • Electrocardiograms, which are often referred to as EKGs or ECGs, are used to measure the electrical impulses of your heart that trigger heartbeats. EKGs are helpful in diagnosing irregular heartbeats and in determining whether other heart problems are present.
  • Computed tomography (CT) scans use radiation to create images of bones and other structures inside your body. CT scans, however, use a computer to construct detailed pictures that can be interpreted by a skilled radiologist.
  • Positron emission tomography scans are more commonly called PET scans. During these diagnostic scans, a small amount of a radioactive drug is introduced into your body. It can be injected, consumed or inhaled. Once it has entered your body, the PET scan detects areas in which the drug has collected. This can help your physician determine potential trouble spots inside your body.

Each of these tests requires that Medicare recipients pay their deductible amount and 20% of the cost of the procedure. Discussing the cost of these tests and screenings with your doctor's office can ensure that you know what to expect financially when undergoing these diagnostic procedures.