Mammograms & Your Insurance 101

Thursday, 30 September 2021


It’s October 1st! Do you know what that means? It’s Breast Cancer Awareness Month!

According to, about 1 in 8 women in America will be diagnosed with breast cancer in her lifetime and about 2,650 new cases of invasive breast cancer are expected to be diagnosed in men this year alone.

We know that these statistics are staggering, and for those who have felt the sting of breast cancer personally, our hearts go out to you.

Early detection is the best medicine, so in honor of Breast Cancer Awareness Month, we’re going to be sharing with you a few insurance tips so you can get the most out of your preventative mammogram benefit.

As a part of ACA guidelines, for those over the age of 40, you are entitled to an annual preventative mammogram! This means that the mammogram should be of no cost to you. Nevertheless, there are certain circumstances where you may get hit with an out-of-pocket bill for your mammogram and it’s good to be aware of them ahead of time:

  • If the visit is coded as “diagnostic” rather than “preventative”. This may happen if you come in with symptoms, lumps, or bumps related to your mammogram
  • If you go to an out of network provider, your preventative mammogram will not be covered, so make sure your physician is within your insurance network
  • If you have any pre-existing conditions related to your mammogram, such as a prior cancer diagnosis, the visit will not be coded as preventive

The best thing you can do before going in for your annual mammogram is ask your doctor prior to your visit what they expect the cost will be based on your situation. It’s also good to know what your insurance carrier mammogram guidelines are before scheduling one for yourself, so be sure to call your insurance carrier using the number on the back of your ID card.

If you have any questions regarding your preventative mammogram and your insurance, or you would like to request an employee benefits group quote, give Clevenger Insurance a call today at 574-267-2181.

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