Does Medicare Cover a Knee MRI? 

Medical imaging has played a vital role in healthcare since the late 1800s, and the addition of magnetic resonance imaging (MRI) in the 1970s opened new possibilities for detecting, diagnosing and treating injuries and disease. Today, the MRI remains one of the most powerful imaging tools used by doctors and specialists in the fight against medical conditions like cancer, infection, tissue damage and developmental anomalies.

How does an MRI work?

MRI technology works by applying a strong magnet over the body. This causes protons to move about as they get pushed and pulled by the resulting magnetic field created by an MRI machine’s magnets. When the machine is turned off, the protons move back to their original formations, and an image of the energy these protons produce is captured and reviewed.

MRI machines are used to view internal organs and bodily systems without the need for more invasive procedures like biopsies. This makes them a good choice when checking for traumatic brain injuries, but they can be used for orthopedic diagnostics like checking the condition of the knee joints.

Does Medicare cover a knee MRI?

Seniors often develop knee conditions through simple wear and tear over the course of their lifetimes or due to injuries suffered during falls. A knee MRI can be used to determine how much protective tissue is left in the knee joint, giving doctors and surgeons an idea as to what course of treatment will be best for each patient.

Medicare coverage for outpatient MRI services

Medicare coverage is available for knee MRI procedures through Medicare Part B. The outpatient benefits of Medicare insurance available through Medicare Part B cover 80% of the cost of approved healthcare expenses, but Medicare recipients must meet an annual deductible before Medicare pays its share. Until the deductible is met, Medicare recipients pay all expenses out of pocket. Medicare Part B also requires a monthly premium that is based on income level and tax filing status.

Medicare coverage for inpatient MRI services

Knee MRIs are often conducted on an outpatient basis since seniors with knee conditions generally have these done when coordinating care with an orthopedic specialist. However, Medicare benefits are also available to pay for knee MRIs in an inpatient setting. If you are hospitalized or admitted to a skilled nursing facility, inpatient Medicare benefits under Medicare Part A cover knee MRI services.

Under Medicare Part A, all inpatient services and approved costs during a hospital stay are covered for 60 days. This differs from skilled nursing facility care which is only covered for 20 days in a benefit period. Despite these program limits, Medicare recipients have the option to extend care by 30 days when admitted to a hospital or 80 days when admitted to a skilled nursing facility. Medicare benefits cover the full cost of a knee MRI when ordered as part of your inpatient care.

Do Medicare Advantage plans cover knee MRIs?

Medicare Advantage plans also cover knee MRIs in a manner consistent with Original Medicare benefits. This is because Medicare Advantage plans contain the same coverage as Original Medicare Part A and Part B, including the inpatient and outpatient benefits.

Medicare recipients who have Medicare Advantage plans may, however, have access to additional benefits that are not included in Original Medicare. Many Medicare Advantage plans offer access to programs like SilverSneakers which may help seniors with knee problems safely engage in physical activity to promote wellness.

Additionally, Medicare Advantage plans may offer access to a wider network of healthcare providers compared to Original Medicare plans. For more information, talk with a Medicare Advantage plan provider or work with an independent Medicare Advantage plan broker.