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How Much Will Medicare Cover If I Need a CT Scan?

Key takeaways Medicare will cover any medically necessary diagnostic tests, including CT scans. Inpatient CT scans are typically covered by Part A, while outpatient CT scans are usually covered by Part B. Part C (also called Medicare Advantage) plans include at least the same level of coverage as parts A and B. Medigap plans can help decrease out-of-pocket costs associated with Original Medicare coverage for CT scans. Medicare will cover any medically necessary diagnostic tests you need. This includes computed tomography (CT) scans. Your exact coverage depends on where you have the test and which Medicare part covers it. Part A coverage for CT scans Part A is hospital insurance. It covers the care you receive during an inpatient stay at: a hospital a skilled nursing facility another inpatient facility This includes any tests your doctor orders during your stay. So, if you receive a CT scan in the hospital, Part A will cover it. In this situation, the cost of a CT scan will go toward your Part A deductible. In 2024, the Part A deductible is $1,632 for each benefit period, and in 2025, it is $1,676. Once you've met this deductible, Part A will cover all tests and procedures during your stay, with no coinsurance costs during the first 60 days of hospitalization. Part B coverage for CT scans Part B is medical insurance. It covers outpatient care at multiple types of healthcare facilities, such as: doctor's offices urgent care centers health centers outpatient clinics outpatient labs and testing facilities surgical centers Part B will cover your CT scan no matter which outpatient setting you have it in. You'll have coverage as long as the facility participates in Medicare and a doctor orders the scan. The Medicare website has a tool for checking which facilities and providers participate in Medicare in your area. After you meet your Part B deductible, Medicare will pay 80% of the approved cost of your CT scan. You'll be responsible for the other 20%. The Medicare Part B deductible is $240 in 2024 and $257 in 2025. Part C coverage for CT scans All Part C plans cover CT scans. However, many Part C plans have networks. You might pay much higher costs for leaving your plan's network. Sometimes, you may not have out-of-network coverage, even if the facility participates in Medicare. The deductible and any copayment or coinsurance amount depend on your specific plan. If possible, contact your insurance company ahead of time to get an estimate of how much this test will cost. Medigap coverage for CT scans Medigap is supplemental insurance that you can buy to cover your out-of-pocket costs from Medicare. Depending on your Medigap plan, you may be able to get coverage for your: Part A deductible Part B deductible Part A copays and coinsurance Part B copays and coinsurance That means that Medigap would cover any costs associated with your CT scan that would typically be your responsibility. Medigap plans have a monthly premium on top of your Medicare Part B premium. So, while you'll pay more each month, the costs will be covered when you need a service like a CT scan. The bottom line Part A will cover your CT scan if you have it during an inpatient hospital stay, and Part B will cover it when you have it as an outpatient. Part C will also cover a CT scan, but you'll typically need to stay within your plan's network. If Medicare doesn't cover your CT scan and you think it should, you can file an appeal. An appeal will give you several chances to explain why the CT scan was medically necessary and see whether Medicare will cover it.