# How Insurance Affects MRI Pricing: Deductibles, Networks, and Prior Authorization Your out-of-pocket cost for an MRI depends on whether you have met your deductible, whether the imaging center is in your insurance network, and whether the scan requires prior authorization. Updated 2026-10-10. Also on the [web page](https://mriprices.fyi/guides/how-insurance-affects-mri-pricing). # How Insurance Affects MRI Pricing: Deductibles, Networks, and Prior Authorization The price you actually pay for an MRI depends very little on the sticker price the imaging center advertises. What you owe is shaped by three main factors in your health insurance plan: your deductible, whether the provider is in network, and whether the scan required prior authorization. ## How deductibles work Most health insurance plans have an annual deductible — the amount you must pay out of pocket before the plan starts covering its share of costs. An MRI is usually subject to this deductible. Until you have met the full deductible for the year, you pay the full allowed amount for the scan. Once the deductible is satisfied, your plan begins to pay, and you may owe only a copay or a coinsurance percentage. Most deductibles reset at the start of the plan year — for many plans that is January 1, but some employers run a different plan year. Check your plan's reset date: an MRI scheduled just before a reset will cost more than the same scan afterward if you have already met this year's deductible. If you have a choice of timing, check where you stand against your deductible before booking. ## In-network vs out-of-network Health insurers negotiate discounted rates with a set of preferred providers called a network. If the imaging center you choose is in your plan's network, the price is based on the negotiated rate, which is usually lower than the center's standard charge. Going out of network changes the calculation. You may be balance-billed — charged the difference between what the center bills and what your insurance pays — and the amount you pay may not count toward your out-of-pocket maximum. Some plans have a separate, higher out-of-network deductible. Before scheduling, confirm that the imaging center is in your plan's network. ## Prior authorization Many health plans require prior authorization before they will cover an MRI. This means the referring doctor must submit clinical information to the insurance company and receive approval ahead of the appointment. If you or your provider skip this step, the plan may deny the claim entirely, leaving you responsible for the full cost. Some plans have exceptions. Emergency MRIs, for example, may not require advance authorization. Medicare handles authorization differently than private insurance. Always check with both your doctor's office and your insurance plan before scheduling. ## Coinsurance and copays After your deductible is met, you typically pay either a copay (a fixed dollar amount per visit) or coinsurance (a percentage of the allowed amount) for an MRI. Coinsurance is more common for diagnostic services like imaging. That percentage can vary from 10% to 40% depending on your plan. ## High-deductible plans and HSAs If you have a high-deductible health plan (HDHP), you pay the full allowed cost of the MRI up to a higher annual deductible. You can use funds from a health savings account (HSA) to pay for the scan with pre-tax dollars, which can save you money even if the scan itself is expensive. ## Medicare and Medicaid Medicare Part B covers MRIs when ordered by a doctor. After the Part B deductible is met, you typically pay 20% coinsurance. Medicare Advantage plans may have different network and authorization rules. Medicaid coverage and cost sharing vary by state. ## How to estimate your cost - Call the imaging center and ask for the CPT code of the specific MRI your doctor ordered - Call your insurance company, give them the CPT code, and ask about your cost under your specific plan - Confirm that the imaging center is in network - Ask whether prior authorization is required and whether it has been submitted - Ask whether the professional fee (radiologist reading) is included in the same coverage Knowing these answers before you schedule is the best way to avoid an unexpected bill. ## Questions ### Do I have to pay my full deductible before insurance covers an MRI? In most plans, yes — the allowed amount counts toward your deductible, and you pay the full negotiated rate until the deductible is met. After that, you pay only a copay or coinsurance for the rest of the plan year. ### What happens if I get an MRI at an out-of-network facility? Out-of-network scans are typically more expensive. You may be charged the facility's full billed rate instead of the negotiated in-network discount, and the amount you pay may not count toward your out-of-pocket maximum. Some plans have separate in-network and out-of-network deductibles. ### Can I be denied an MRI by my insurance? Yes. Insurers can deny coverage for an MRI — most often when prior authorization was skipped or the plan does not consider the scan medically necessary. Note that an approved prior authorization confirms medical necessity but does not by itself guarantee payment; benefit limits and network rules still apply.