MRI Cost With Medicare: Part B 20% Coinsurance Mechanics 2026

Original Medicare (Part B) covers 80 percent of the Medicare-approved MRI rate after the $240 annual Part B deductible. The patient pays 20 percent. For most MRI at a non-facility setting, that 20 percent is $50 to $200 out-of-pocket; at a hospital outpatient department, it is materially more.

How Medicare Part B pays for MRI

Medicare Part B (outpatient medical services) covers diagnostic MRI when ordered by a Medicare-participating physician with appropriate medical justification. The Medicare-approved amount is set by either the Physician Fee Schedule (for non-facility outpatient settings, including most freestanding imaging centres that have Medicare-enrolled physicians) or the Hospital Outpatient Prospective Payment System (for hospital outpatient departments).

The patient is responsible for the annual Part B deductible ($240 in 2026, applied once per year across all Part B services) plus 20 percent coinsurance on each service. For an MRI at a non-facility setting, the math is: deductible (if not yet met) plus 20 percent of the Medicare-approved amount. After deductible is met, only the 20 percent applies.

For example, a Medicare patient having lumbar spine MRI (CPT 72148) at a freestanding imaging centre with the annual deductible already met: Medicare-approved amount ~$254 global; Medicare pays 80 percent ($203); patient pays 20 percent ($51). At a hospital outpatient department, the OPPS payment is approximately $1,100 to $1,400 for the same code; 20 percent coinsurance comes to $220 to $280.

Medigap supplement insurance and MRI cost

Medigap (Medicare Supplement Insurance) is private insurance that covers some or all of the Original Medicare patient-responsibility portion. Plan letters G, F (for those eligible before 2020), and N are the most common comprehensive supplements. With Plan G, the patient pays only the $240 annual Part B deductible (across all services in a year); after that, Medigap pays the entire 20 percent coinsurance on Medicare-approved services including MRI.

For Medicare patients with Plan G or equivalent comprehensive Medigap, MRI is effectively free at the point of service after the first scan of the calendar year (which exhausts the $240 deductible). This is the cheapest US-resident pathway to MRI in 2026, often cheaper than any commercial-insurance scenario.

Medicare Advantage MRI cost

Medicare Advantage (Part C) plans are run by private insurers under contract with Medicare. They are required to cover the same services as Original Medicare but typically have different cost structures, networks, and pre-authorisation requirements. MRI under most Advantage plans requires pre-authorisation (just like commercial insurance) and in-network facility use.

Typical Medicare Advantage MRI out-of-pocket in 2026 runs $50 to $300 per scan at in-network freestanding imaging centres and $200 to $500 at hospital outpatient departments. Out-of-pocket maximums apply (CMS sets a maximum of $9,350 for in-network in 2026, though most plans cap lower). Out-of-network MRI may not be covered or may be covered at substantially reduced rates.

For Medicare Advantage patients, the cost-mechanics are closer to commercial insurance than to Original Medicare: pre-auth matters, network status matters, deductible may apply. Always verify the specific plan terms before booking.

Where Medicare patients should get their MRI

For Medicare patients with a choice, asking the ordering physician to write the imaging order specifically to a freestanding imaging centre (rather than a hospital outpatient department) usually saves the patient hundreds of dollars per scan because of the difference between Physician Fee Schedule and OPPS pricing. The clinical scan is identical; only the billing differs.

The exception is when the patient has a complex condition or implanted device that requires hospital-level radiology support. In those cases the hospital pathway is clinically right and the cost difference is part of the scan cost. For routine knee, shoulder, hip, spine MRI, freestanding is almost always the right choice for Medicare patients.

Sources used on this page

• Medicare.gov MRI coverage
• CMS Physician Fee Schedule, 2026
• CMS Hospital Outpatient PPS
• Medicare.gov Medigap overview

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