Does job-based or Marketplace insurance cover PET scan?

Covered for certain conditions, usually with prior authorization. PET scans are covered mainly for cancer diagnosis, staging, and monitoring, and certain heart and brain conditions. Coverage criteria are specific. Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.

Does Original Medicare cover PET scan?

Covered for certain approved conditions. Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.

Does Medicare Advantage cover PET scan?

Covered for certain approved conditions. Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions. Medicare Advantage plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.

Does Medicaid cover PET scan?

Covered when criteria are met, with prior authorization. Each state sets its own rules for when a scan like this counts as medically needed.

Is PET scan covered by insurance?

Nuclear imaging, often used for cancer staging. Here’s how each kind of plan usually handles it.

Ask a specific question Plan a visit: cost and doctors Check it against my plan

Employer or MarketplaceCovered with conditions
Covered for certain conditions, usually with prior authorization.
More details
PET scans are covered mainly for cancer diagnosis, staging, and monitoring, and certain heart and brain conditions. Coverage criteria are specific.
Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.
Original MedicareCovered with conditions
Covered for certain approved conditions.
More details
Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions.
Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageCovered with conditions
Covered for certain approved conditions.
More details
Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions. plans must cover this too, but set their own copays and often require providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions
Covered when criteria are met, with prior authorization.
More details
Each state sets its own rules for when a scan like this counts as medically needed.

Plan type	How it’s usually covered
Employer or MarketplaceCovered with conditions	Covered for certain conditions, usually with prior authorization. PET scans are covered mainly for cancer diagnosis, staging, and monitoring, and certain heart and brain conditions. Coverage criteria are specific. Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.
Original MedicareCovered with conditions	Covered for certain approved conditions. Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageCovered with conditions	Covered for certain approved conditions. Medicare covers PET scans under national coverage rules, mainly for cancer and certain heart and neurological conditions. plans must cover this too, but set their own copays and often require providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions	Covered when criteria are met, with prior authorization. Each state sets its own rules for when a scan like this counts as medically needed.

What usually has to be true

The indication must match the plan’s policy.
Plans usually require prior authorization.

Good to know

Amyloid PET coverage for Alzheimer’s has expanded but remains criteria-based.

MRI · Magnetic resonance imaging (including MRA).
Cancer treatment · Chemotherapy, radiation, immunotherapy, and oncology care.

Sources

Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.

1
What Marketplace plans cover
HealthCare.gov
Marketplace plans cover outpatient care, hospitalization, mental health care, prescription drugs, rehabilitation, laboratory services, preventive services, and other essential benefit categories.
2
Diagnostic non-laboratory tests
Medicare.gov
Part B covers diagnostic tests such as CT scans, MRIs, EKGs, X-rays, and PET scans when a doctor orders them to treat a medical problem; you generally pay 20% after the deductible.
3
Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
4
Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.

General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.

Is PET scan covered by insurance?

What usually has to be true

Good to know

Related

Sources