Does Medicare Pay for MRIs?
Your doctor orders an MRI. Now what?
For many seniors, the next thought isn’t about the scan itself — it’s whether Medicare will pay for it. Figuring out coverage sometimes feels like solving a puzzle with missing pieces, and the last thing anyone wants is an unexpected bill.
MRIs are one of the most commonly used diagnostic tools in modern medicine. According to the National Library of Medicine, nearly 40 million MRI scans are performed in the U.S. each year. These tools help doctors detect everything from joint damage to neurological conditions.
Despite the routine nature of MRIs, many Medicare beneficiaries still don’t know if or how they’re covered by medical insurance.
Health concerns are stressful enough without Medicare rules adding to the confusion. Looking for guidance? Senior Insurance Agency is here for you.
Whether you’re wondering if Medicare covers your MRI scan, how much you’ll owe, or what to do if a claim is denied, we will help you make sense of it so you can focus on your health more than your paperwork.
Today, let’s talk about MRIs on the blog. Here’s what you should know:
Table of Content
1. What Is an MRI, and When Is It Important?
2. Does Medicare Cover MRI Scans?
3. Requirements for Medicare to Cover an MRI
4. What Will You Pay for an MRI Scan Under Medicare?
5. Medicare Advantage Plans and MRIs
6. What If Medicare Doesn’t Cover Your MRI?
7. MRIs & Medicare: Let’s Make Sense of It All
What Is an MRI, and When Is It Important?
An MRI, or Magnetic Resonance Imaging, is a powerful medical tool that helps doctors see what’s happening inside the body — without surgery or radiation. It uses a strong magnetic field and radio waves to create detailed images of organs, tissues, and bones.
Unlike X-rays or CT scans, an MRI captures soft tissue in high definition, making it especially useful for spotting issues that might not show up on other tests.
Doctors order MRIs for a wide range of reasons. A lingering knee injury, unexplained headaches, or persistent back pain could all lead to an MRI to check for underlying issues.
These scans help diagnose joint damage, nerve disorders, tumors, and even early signs of stroke. For patients with chronic conditions, an MRI tracks progress and guides treatment plans.
Beyond pinpointing problems, MRIs offer something just as valuable: peace of mind. When symptoms don’t have an obvious cause, an MRI can provide answers.
Knowing what’s wrong — or ruling out serious conditions — helps patients and their doctors make confident, informed decisions about the next steps.
Does Medicare Cover MRI Scans?
Medicare does cover MRIs, but not in every situation. Coverage depends on where the MRI is performed and whether it’s considered “medically necessary” by a doctor.
If an MRI is done while you are admitted to a hospital, Medicare Part A typically covers it as part of your inpatient stay. In this case, the cost is included in what you owe for hospitalization rather than being billed separately.
For MRIs performed outside of a hospital stay, Medicare Part B provides coverage — so long as the scan is medically necessary. Your doctor must determine that the MRI is required to diagnose or treat a condition.
Even with coverage, patients are responsible for 20 percent of the Medicare-approved cost after meeting their deductible. The scan must also be performed at a facility that accepts Medicare, or you may face additional out-of-pocket costs. Medigap Plan G, N or F will help pick that 20% up for you.
Medicare does not cover MRIs just because a patient requests one. If a doctor or healthcare provider cannot justify the need for the scan, Medicare may deny coverage, leaving the patient responsible for the full cost.
Before scheduling an MRI, it’s always a good idea to confirm that it’s approved to avoid unexpected expenses.
Find Out Medicare Coverage for MRIs!
Requirements for Medicare to Cover an MRI
To meet Medicare’s requirements, a doctor must submit documentation explaining why the MRI is necessary. This includes details about symptoms, previous test results, and why alternative diagnostic methods may not be sufficient.
For example, if a patient has been experiencing persistent back pain after a fall, but X-rays and physical therapy have not provided answers, a doctor may order an MRI to check for nerve compression or spinal damage.
Similarly, someone with unexplained dizziness and headaches may need an MRI to rule out neurological issues such as a tumor or stroke.
Medicare coverage generally requires the following conditions to be met for an MRI to be covered:
- A doctor must determine whether the MRI is medically necessary for diagnosing or treating a condition.
- The doctor must submit documentation explaining why the scan is required.
- The MRI must be performed at a facility that accepts Medicare to avoid additional costs.
- Prior authorization may be required, depending on the type of MRI and whether the patient is enrolled in a Medicare Advantage plan.
Because coverage rules vary, confirm details with both the doctor and Medicare before scheduling to avoid unexpected MRI costs.
What Will You Pay for an MRI Scan Under Medicare?
The cost of an MRI under Medicare depends on whether it is performed during a hospital stay or as an outpatient procedure. While Medicare covers certain costs, patients are still responsible for other out-of-pocket expenses.
If an MRI is performed while you are admitted to a hospital, Medicare Part A typically covers it as part of your inpatient stay. This means you won’t receive a separate bill for the scan itself. However, you may still face hospital-related costs, such as deductibles or coinsurance, depending on how long you remain hospitalized.
For outpatient MRIs, Medicare Part B applies. After meeting the Part B deductible, patients are responsible for 20 percent of the Medicare-approved amount for the scan. The total cost can vary based on the type of MRI, where it’s performed, and whether the facility accepts Medicare.
Where you get your MRI matters. Choosing a Medicare-approved provider can significantly reduce out-of-pocket expenses. If the scan is performed at an out-of-network facility, Medicare may cover less, leaving you with a much higher bill.
For patients in Nevada, pricing and coverage details differ based on local providers and Medicare Advantage plans. Some Advantage plans may cover MRIs at a lower cost, while others may require referrals or pre-approvals.
Before scheduling an MRI, it’s always a good idea to check with both Medicare and your provider to fully explore how much you’ll owe.
Can Medicare Help You Pay for MRIs?
Medicare Advantage Plans and MRIs
Medicare Advantage Plans, also known as Part C, provide an alternative to Original Medicare and often come with additional benefits, including different levels of MRI coverage. While Advantage plans must cover at least what Original Medicare does, many go beyond that by reducing out-of-pocket costs or offering extra benefits.
Some plans may fully cover the cost of an MRI when performed at an in-network facility, eliminating the 20% coinsurance required under Medicare Part B. Others may offer lower copays, include MRIs in bundled diagnostic nonlaboratory tests or services, or provide additional flexibility in where the scan can be performed.
However, coverage rules can vary significantly from plan to plan.
For example, a Medicare Advantage HMO might require a referral and prior authorization before approving an MRI, while a PPO plan may allow more freedom to schedule a scan without extra referral paperwork. In Nevada, where provider networks differ, Medicare Advantage enrollees must confirm whether their plan covers MRIs at their preferred facility.
Because benefits and requirements vary, checking directly with your Medicare Advantage plan provider is the most effective way to understand your specific coverage. Before scheduling an MRI, ask about costs, network restrictions, and any necessary approvals to avoid unexpected expenses.
What If Medicare Doesn’t Cover Your MRI?
Finding out that Medicare won’t cover your MRI can be frustrating, but there are steps you can take to avoid paying the full cost out of pocket. In many cases, coverage issues come down to medical necessity, provider acceptance, or prior authorization, and there may still be options to get the scan covered.
Here are some steps you can take:
(1) Work with your doctor to confirm that Medicare will approve the MRI.
Medicare requires a strong medical justification for coverage, so your doctor must clearly document why the scan is necessary for diagnosis or treatment. If coverage is denied, it may be worth asking your doctor if additional documentation or a pre-approval request could change the decision.
(2) Before scheduling an MRI, confirm that the facility accepts Medicare.
If the provider is out of network, Medicare may not cover the scan, leaving you responsible for the full cost. This is especially important for patients in rural areas like parts of Nevada, where provider options may be more limited.
Some facilities may also require pre-approval for MRIs, particularly under Medicare Advantage plans, so checking in advance helps prevent unexpected expenses.
(3) Speak with a Senior Insurance Agency representative.
Struggling with billing issues or unsure about your coverage options? Our team will review your Medicare plan, explain potential alternatives, and assist in navigating the appeals process if a claim is denied. In some cases, Medicare Supplement (Medigap) or Medicare Advantage plans may offer better coverage options for future scans.
Learn If Medicare Covers Your MRI Needs!
MRIs & Medicare: Let’s Make Sense of It All
Healthcare decisions can be daunting, especially when it comes to Medicare coverage. Whether scheduling a scan, sorting through coverage details, or just trying to figure out what comes next, having guidance makes all the difference.
If Medicare rules seem confusing, you’re not alone — and you don’t have to face them on your own. Senior Insurance Agency’s team will break down your coverage options, clarify costs, and help you make the most of your Medicare plan.
Have questions about your MRI coverage? Peace of mind starts with understanding your benefits, and we’re here to make that process easier. Reach out today!