Does health insurance cover MRI scans?

Your first MRI scan might be intimidating, not only because you’re heading into unknown territory, but also because of hefty bill you might be expecting. Rest assured, MRI scans are relatively routine and will not cause you pain.

Paying for your MRI is another story—they can cost hundreds of dollars. So, what kind of financial support can you expect from Medicare and private health insurance for your MRI? How can you bring your bill down?

Medicare and MRI scans

Not all MRI machines can provide Medicare eligible services and some of those that can have limitations, like.

• Full Medicare-eligible MRI units can provide all the MRI items listed on the Medicare Benefits Schedule (MBS) with a Medicare rebate for the patient.
• Partial Medicare-eligible MRI units can only provide a subset of MRI items listed on the Medicare Benefits Schedule (MBS) for which there is a Medicare benefit for the patient. If you receive an MRI from a Partial Medicare-eligible MRI unit and the service is outside the scope of the subset of approved services, no Medicare benefit will be payable. That means you’ll have to pay the full cost of the service.

It’s important that you ascertain if the service you require will be covered by Medicare at your MRI provider.

MRI scans while you’re a hospital patient

Medicare will almost always provide coverage for your MRI scan, provided it’s necessary, and has been ordered by an appropriate health care provider on an eligible MRI unit. You can find out more about Medicare eligibility by checking out the table.

To receive a full rebate from Medicare, you will need to receive the MRI scan as a public patient in a public hospital. Those who are treated as a private patient in either a public or private hospital and receive the scan from a full Medicare eligible MRI unit will likely have a gap between the cost of the procedure and what Medicare will pay for.

Does health insurance cover MRI scans?

Medicare fully covers MRI scans, but only for people who receive treatment as a public patient in a public facility.

When you receive an MRI as a private patient you will only receive a percentage of the total cost back from Medicare, when the service is performed by a Medicare eligible MRI unit.

MRI scans are also covered by private health insurance, provided the service is recognised my Medicare, you have the service listed on your policy and you receive the scan while you are an admitted private patient (in a hospital). An appropriate policy will cover all or part of the gap, being the difference between the Medicare benefit and the cost of the service

MRIs can cost anywhere from $100 to $500, so you could end up paying over $300 for your MRI out of your pocket.

Having appropriate private health cover is one way to minimise or avoid this out-of-pocket expense. Private health insurance also allows you to receive treatment as a private patient and to choose your doctor.

Covering the gap cost of an MRI is only one of the many ways private health insurance can save you money. It can provide assistance for other treatments, procedures and health services that are important for you. Speaking to an adviser is a great way to make sure your policy is still working as it should, covering you adequately and competitively-priced.

In addition to the dollar savings, health cover may also help you avoid any waiting lists associated with the procedure.

What to expect from an MRI

MRI stands for magnetic resonance imaging, which is an accurate description of the procedure. The device uses strong magnets to realign hydrogen atoms in your body and pick up the radio waves it emits. The images are layered on top of one another to create a detailed and comprehensive image of an area of your body.

More simply put, the MRI uses magnets to create an image of the inside of your body.

Doctors will use an MRI to diagnose all kinds of ailments. MRIs are particularly useful because they can detect illnesses and injuries that X-rays, ultrasounds, and CT scans can’t.

When undergoing an MRI, all you have to do is lie down and stay still. This can be more difficult than it sounds, especially for those who are claustrophobic. The MRI is a tight space, and all the loud noises it makes can be a bit daunting.

Still, you won’t feel anything as the MRI gathers its images. You can even listen to music or a podcast while you lay there. MRIs generally take around 45 minutes to complete.

Since the machine is layering images on top of one another, movement can disrupt the process and force the doctor to start all over again. Remember to stay as still as possible—this should hopefully speed up the process.

Preparation

For most areas of the body, preparation is not usually necessary for an MRI. In some cases—such as a pelvic or abdominal MRI—the doctor will request that you don’t eat anything for a specified duration of time before the appointment.

You will be asked to remove any metal such as watches or jewellery before entering the machine. Those who have metal implants often aren’t able to receive an MRI for that reason—at least in certain parts of their bodies.

MRIs use powerful magnets, which is the reason you’ll need to remove all of the metal from your body.

Purchasing private health insurance

Covering the MRI gap cost is one of the many benefits of having private health insurance. You’ll likely be able to get in the door quicker and choose your doctor.
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