Is an MRI Covered by Insurance?
Magnetic Resonance Imaging (MRI) is one of the most common diagnostic tests ordered by doctors to detect internal injuries, brain trauma, spinal cord damage, joint issues, and other serious medical conditions. While the test is often medically necessary, it can also be very expensive, with costs ranging anywhere from $375 to over $3,500 depending on the type of MRI, the facility, and whether contrast dye is used.
That leads many patients to ask an important question: Is an MRI covered by insurance?
The answer is that most health insurance plans, including employer-sponsored, marketplace, and government plans such as Medicare and Medicaid, typically cover MRIs when they are deemed medically necessary. However, there are often conditions, restrictions, and out-of-pocket costs you need to understand before scheduling the procedure.
This article will break down how insurance coverage for MRIs works, what costs you may still face, and how to advocate for yourself if your claim is denied.
What Is an MRI and Why Is It Ordered?
An MRI scan uses powerful magnets and radio waves to create detailed images of your organs, tissues, and bones. Doctors often order MRIs to:
Detect traumatic brain injury or concussion
Evaluate spinal cord or nerve damage after an accident
Examine torn ligaments or cartilage in joints
Identify tumors or internal bleeding
Monitor recovery progress after surgery
Because MRIs provide highly detailed imaging without radiation exposure (unlike CT scans or X-rays), they are considered one of the safest and most accurate diagnostic tools.
Are MRIs Typically Covered by Insurance?
In most cases, yes—insurance will cover an MRI if your doctor orders it for a valid medical reason. Insurance companies generally classify MRIs as “diagnostic imaging services.” Coverage depends on:
Medical necessity – Your doctor must explain why the test is needed.
Plan benefits – Some plans may cover MRIs more fully than others.
Provider network – Using an in-network hospital or imaging center will usually result in lower costs.
Pre-authorization – Many insurers require prior approval before the scan.
For example, if you were injured in a car accident and your doctor suspects spinal cord damage, your insurer will likely cover the MRI as long as it is medically necessary and performed at an approved facility.
When an MRI May Not Be Covered
There are situations where insurance may deny or limit MRI coverage:
No documented medical necessity – If your doctor does not provide a detailed reason for the scan.
Experimental or screening purposes – MRIs ordered as a precaution without symptoms may not be covered.
Out-of-network provider – Using a facility outside of your plan’s network may lead to higher costs or no coverage at all.
No prior authorization – Failing to get approval from your insurer beforehand may result in denial.
Out-of-Pocket Costs for an MRI
Even if your MRI is covered, you may still face expenses such as:
Copayments – A fixed amount you pay when receiving the service.
Deductible – The amount you must pay out of pocket before insurance begins covering costs.
Coinsurance – A percentage of the MRI bill you’re responsible for after meeting your deductible.
Out-of-network charges – Additional bills if you use a facility not covered by your plan.
According to the Healthcare Bluebook, the average fair price for an MRI is between $500 and $3,000, depending on the type of scan and whether contrast dye is used.
MRI Coverage by Insurance Type
Employer-Sponsored or Marketplace Plans
Most private insurance plans cover MRIs when medically necessary, but you will likely need pre-authorization.
Medicare
Medicare Part B covers MRIs if ordered by a doctor and performed in a Medicare-approved facility. You typically pay 20% of the Medicare-approved amount after meeting the Part B deductible.
Medicaid
Coverage varies by state but usually includes MRIs if considered medically necessary. Prior authorization is often required.
Steps to Take Before Scheduling an MRI
Get a doctor’s order – Insurance won’t cover an MRI without a physician’s referral.
Check pre-authorization requirements – Call your insurer or ask your doctor’s office to confirm.
Choose an in-network facility – This can save you thousands in out-of-pocket costs.
Ask for cost estimates – Many imaging centers can provide upfront pricing.
Keep detailed records – In case you need to appeal a denial later.
What to Do if Insurance Denies Your MRI Claim
Insurance companies sometimes deny MRI coverage, even when your doctor recommends it. If this happens:
Request the denial letter – It must explain why coverage was denied.
Work with your doctor – They can submit additional medical records or notes supporting medical necessity.
File an appeal – Most insurers allow you to formally challenge denials.
Seek patient advocacy help – Some hospitals and clinics have staff who assist with insurance appeals.
MRIs After an Accident and Personal Injury Claims
If you were injured in an accident caused by someone else’s negligence, your personal injury claim may include medical imaging costs such as MRIs. Even if your health insurance covers part of the expense, you could still pursue reimbursement for deductibles, copays, and other related costs through a legal claim.
Working with a personal injury lawyer in Texas can help ensure all medical expenses—including MRIs—are fully documented and pursued in your injury claim.
FAQs About MRI Insurance Coverage
Is an MRI always covered by insurance?
No. It must be deemed medically necessary and usually requires prior authorization.
How much does an MRI cost without insurance?
An MRI can cost between $375 and $3,500 or more depending on the type and location.
Does Medicare cover MRIs?
Yes, Medicare Part B covers medically necessary MRIs, but you may still owe 20% coinsurance.
Do I need prior authorization for an MRI?
Most insurance plans require prior authorization, especially for high-cost imaging like MRIs.
Can accident-related MRIs be included in a legal claim?
Yes. If another party is responsible for your injuries, MRI costs may be part of your personal injury claim.
Final Thoughts
MRIs are powerful diagnostic tools that can help detect injuries and illnesses early. While most insurance plans cover MRIs when medically necessary, you may still face out-of-pocket expenses. Always confirm coverage with your insurer, get pre-authorization, and use in-network providers whenever possible.
If your MRI is related to an accident caused by someone else’s negligence, a personal injury attorney can help you seek reimbursement for all associated costs. At Carrollton Injury Law, we put the personal back into personal injury law and are committed to helping clients across Texas pursue the full compensation they deserve.
