Yes, health insurance can cover MRI scan costs if the scan is medically necessary and prescribed by a doctor. In most cases, MRI expenses are covered when they are part of a covered treatment or hospitalisation. If the MRI is done without hospital admission, then coverage depends on whether your health insurance plan includes OPD (Outpatient Department) benefits.
Is an MRI Scan an Imaging Test?
Imaging tests are diagnostic procedures that create images of structures inside the body. They are used by doctors to detect diseases, injuries, and other medical issues. The MRI (Magnetic Resonance Imaging) scan is a kind of imaging test. Some examples of other imaging tests are CT scans, PET scans, X-rays, ultrasounds, mammography, and bone scans.
Imaging coverage in health insurance refers to whether the insurance covers the costs of imaging tests. Whether an MRI scan is covered depends on factors such as hospitalisation, pre- and post-hospitalisation care, and OPD benefits available under the health insurance plan.
When Does Health Insurance Pay for an MRI in a Hospital?
Health insurance may cover the cost of an MRI scan if your doctor recommends it during a covered hospitalisation. Provided that your case meets the conditions of the policy, then the scan would qualify as any other medical service in the hospital.
Coverage may also extend to the pre- and post-hospitalisation period. Many health insurance policies cover tests taken within a period of 30 to 60 days before hospitalisation. Tests taken within 90 to 180 days after discharge will also be covered.
So a policy will usually pay for an MRI in these cases:
It is required during a hospital stay.
It is performed before a planned admission as part of the treatment process.
It is needed for follow-up care or recovery after discharge.
OPD and diagnostic benefits change the answer
If your policy includes an OPD (outpatient department) benefit or a diagnostic-test rider, a standalone MRI can be reimbursed up to the benefit limit even without hospitalisation. Check whether your plan has this add-on before assuming a scan will be paid.
Is an Outpatient MRI Scan Covered by Health Insurance?
Yes, a health insurance policy will cover an MRI test done on an outpatient basis if it includes OPD cover. An OPD cover in health insurance helps pay for medical expenses incurred without hospital admission, such as doctor consultations and diagnostic tests. If your plan includes this benefit, you can claim the cost of a prescribed MRI test up to the limit specified in your policy.
What Does an MRI Cost Under a Health Insurance Plan?
The cost of an MRI depends on the body part scanned, the healthcare facility, the city, and whether contrast material is used.
| Facility type | cost range |
|---|---|
| Private hospital or diagnostic centre | ₹5,000–₹20,000+ |
| Government hospital | Usually lower than private facilities |
| MRI with contrast | May cost more than a standard MRI |
How Do You Claim an MRI Scan on Health Insurance?
To claim an MRI scan on health insurance, make sure the scan is tied to treatment and keep every document. A few simple steps decide whether the claim goes through:
1. Confirm the MRI is covered under your policy, whether through hospitalisation, pre- and post-hospitalisation benefits, or OPD coverage.
2. Keep the doctor's note that says why the MRI is needed.
3. For a cashless claim, check whether pre-authorisation is required and ask the hospital's insurance desk to assist.
4. In case you file a reimbursement claim, please be sure to have the MRI receipt, scan report, and doctor’s prescription ready for submission.
While purchasing or renewing your health insurance policy, ensure that the plan covers the cost of diagnostic tests.
Conclusion
Health insurance can cover MRI scan costs when the test is medically necessary and linked to a covered treatment. MRI scans performed during hospitalisation, or within the eligible pre- and post-hospitalisation period, are often covered under the policy terms. If the scan is done without hospital admission, coverage usually depends on whether the plan includes OPD benefits.
Frequently asked questions
Yes, an MRI scan can be covered by health insurance if it is medically necessary and prescribed by a doctor. If the MRI is done without hospital admission, it may be covered only if your health plan includes OPD benefits.
Yes. CT, PET, and MRI scans are generally covered when they are part of hospital treatment or come under pre-hospitalisation and post-hospitalisation benefits offered in your health insurance plan. If the scan is done on an outpatient basis, coverage requires OPD benefits.
If the MRI is covered, the policy pays the full eligible amount, less any sub-limit (a cap on a specific kind of claim) your plan sets. In case the test is not accompanied by hospitalisation, then it would be reimbursed only up to the OPD limit.
Yes. You can submit your reimbursement claim using the bill, your doctor's certificate, and the MRI report.
It depends on your specific health plan. If the MRI is related to a condition such as a pre-existing disease or a specified illness, the claim may be covered only after the applicable waiting period has been completed.
About the authors
Neviya Laishram
Written by · Senior Editor – Health, Life and Group Health Insurance Content at ACKOWith a journalism background, she brings 9 years of experience in strategising and editing health, life, and group health insurance content. Having written for magazines and digital publications, she combines research and editorial expertise to create credible, useful content for readers.
Dr Nitin Kumar Gupta
Reviewed by · SVP – Health Underwriting & Claims at ACKO General InsuranceWith 20+ years of experience in digital transformation and growth, he is a leader specialising in health, life, accident, and disability insurance. Backed by an MBBS degree and insurance designations (FLMI, FALU, FLHC, ACS, ARA), he combines expertise with leadership.
