Determining whether your health insurance will cover certain procedures can help you control your healthcare costs and make financially sound decisions regarding the services you obtain. While MRIs are generally covered by health insurance, it is left to the discretion of your health insurance company to decide whether the test is medically necessary. If your provider determines that it is not, then you may pay for the procedure out-of-pocket.

What is an MRI?

Magnetic Resonance Imaging

An MRI, is a noninvasive medical imaging test that produces detailed images of almost every internal structure in the human body, including the organs, bones, muscles and blood vessels. MRI scanners create images of the body using a large magnet and radio waves.

How Much Do MRIs Cost?

Medical imaging is expensive, but how much you pay for a test ranges widely depending on the healthcare provider and health care prices in your region. On average, fees typically range between $500 and $3,000, but your bills may be even higher.

If your health insurance company determines that an MRI is medically necessary, then the test is typically covered. However, this does not necessarily mean that it will cost you nothing. Depending on your health insurance plan, you may have to meet a deductible before your policy pays for anything while some insurance plans you will pay a co-pay. If you do not have a co-pay, and you have already met your deductible, you would pay a percentage of the price, called coinsurance. If you have met your “out of pocket maximum” this means you are not required to pay anything for the remainder of the calendar year. The “out of pocket maximum” is the most you will pay for anything medically necessary for the remainder of the year, and this includes prescriptions. You would want to look at your policy’s “Summary of Benefits” for further information regarding your plan.

The portion of the cost your health insurance pays also depends on whether you see an in-network provider. Many health insurance plans have network providers that agree to the plan’s payment terms. If you have an HMO, your health insurance usually only pays for care you get from an in-network provider. If you get services from an out-of-network provider, you generally pay the entire bill, because HMO plans do not have coverage out of their network. If you have a PPO, your policy covers care from out-of-network providers, but you pay much less if you stay in-network.