Medicare covers echocardiograms if they’re medically necessary. Your doctor may order an electrocardiogram, or EKG, to measure your heart’s health. Medicare will also pay for one routine screening EKG during your first year on Medicare. In the content below, we’ll look at the guidelines, coverage, and common questions relating to Medicare coverage for EKGs and ECGs.
How Does Medicare Cover an Echocardiogram?
Although the names are similar, an electrocardiogram (EKG) is not the same as an echocardiogram. An echocardiogram, or echo, uses sound waves to produce moving pictures of your heart. Also known as a heart ultrasound, it shows your heart’s size and shape and how well the heart and valves are working.
Medicare covers echocardiograms if they’re necessary. Coverage works the same way as for electrocardiograms: if you’re an outpatient, Part B covers the procedure. If you’re an inpatient, your Part A coverage applies.
Does Medicare pay for a routine EKG?
Medicare will only pay for one screening EKG in your lifetime. To be covered, your doctor must order the EKG as part of your “Welcome to Medicare” visit.
That visit must happen during the first 12 months you’re on Medicare. Otherwise, Medicare won’t pay for an EKG without some indication that the EKG is necessary to diagnose or monitor a condition.
Is there a Welcome to Medicare EKG?
Within 12 months after enrolling in Medicare, you can see your doctor for a “Welcome to Medicare” visit. If your doctor orders an EKG at that time, Part B will cover it as a preventive screening. This is the only time Medicare will cover a routine screening EKG.
Your doctor may perform your Welcome to Medicare EKG at the office or send you to an outpatient facility. Either way, Part B will pay a portion of the Medicare-approved rate for the procedure.
You’ll be billed for deductibles and copays if you don’t have a Medigap plan. You may also owe a hospital copay if you get your EKG at a hospital or a clinic owned by a hospital.
Does Medicare cover a stress test?
Your doctor may order a stress test to find out how well your heart works while you exercise. Most stress tests involve walking on a treadmill or riding a stationary bike.
However, in some cases, your doctor may give you drugs to imitate the effects of exercise on your heart. Nuclear stress tests and echocardiographic stress tests include imaging as part of the procedure.
No matter what type of stress test you have, Medicare will cover the test if it’s necessary. Coverage falls under Part A if you’re an in-patient, and Part B if you’re not.
Medicare Guidelines for a Diagnostic Electrocardiogram
Medicare will pay for an unlimited number of diagnostic EKGs. But, for the test to be considered “diagnostic,” it must be necessary.
An EKG might be needed because:
- You have symptoms that could indicate heart disease, and your doctor wants to confirm or rule out heart problems
- You have heart disease, and your doctor wants to monitor your condition
- Your doctor orders an EKG before you undergo surgery
If you have an EKG as an outpatient, Part B covers a portion of the cost. If you are an inpatient at a hospital, Part A covers your EKG.
Part A has a larger deductible, but once you’ve met it, Medicare covers all your hospitalization costs for the first 60 days you’re in the hospital.
Medicare Advantage Coverage for an EKG or ECG
Medicare Advantage plans must cover the same services as Medicare. But the insurance companies that sell Medicare Advantage policies set the deductibles, copays, and co-insurance.
Advantage plans also have doctor networks. So, you’ll pay less if you use an in-network doctor.
If you have Medicare Advantage, EKG coverage follows the same rules as in Medicare. But your costs may be different.
To avoid unexpected bills, make sure the doctors administering your EKG are in your plan’s network.
Can Medigap Lower Costs of an EKG?
With Medicare alone, you pay a portion of the bill for an EKG or any other outpatient procedure or doctor visit. But, if you buy a Medigap plan, Medigap can cover the gaps you’d otherwise pay. Depending on the plan you qualify for and choose, you may not owe anything for your medical care.
How to Get Help Managing a Heart Condition with Medicare
If you develop a heart condition, your doctor will want to monitor your health, and you may need heart procedures in the future. Medicare covers a portion of your costs, but, caring for a heart condition can get costly.
A Medigap plan avoids the financial risk by paying all or part of the bill that Medicare doesn’t pay. Medigap can cover most of your medical bills for an affordable monthly premium.
MedicareFAQ can help you find the Medigap plan that’s right for you. Just call us or fill out our form and we’ll get started on a free quote.