Some older women need additional breast exams. Why doesn't Medicare pay?

Mammograms may miss tumors in women with dense breasts, so their doctors often include an ultrasound or MRI. analysis. Patients often end up paying the bill.

Mammograms may miss tumors in women with dense breast tissue. So, for these patients, doctors often include a second scan – an ultrasound, for example, or an MRI. – which are more likely to trigger cancers at an early stage.

But some elderly patients find themselves faced with an unexpected twist. Although many women consider the additional scan a form of routine prevention, Medicare will not pay for it and some patients face a hefty bill.

Joellen Sommer, 66, who lives in Manhattan, went for her annual breast cancer screening in March. But clinic staff said that while her mammogram would be fully covered by Medicare, a so-called additional ultrasound was not.

Mrs. Sommer has dense breasts and a family history of breast cancer. She said she has had mammograms and ultrasounds throughout her adult life. "I just don't understand how a diagnostic test that has been recommended for years is suddenly no longer covered by Medicare," she said.

"Ma mother had breast cancer, my aunt had breast cancer – I guess that's not enough,” she added. “I wonder if it was a test for them. men, if the same problem would arise."

Lenox Hill Radiology in New York has begun warning patients that if they are insured by Medicare, they may need pay up to $450 if they have a breast ultrasound, even if the breast tissue is known to be dense and the additional scan is done on the same day as a screening mammogram.

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