Medicare Part A will cover an echocardiogram in an inpatient hospital stay. Part B covers the procedure in the emergency room, doctor’s office, or an outpatient facility.
You may be responsible for deductibles or co-insurance. If you have a Medigap plan or a Medicare Advantage plan, those plans may pay some or all your coinsurance or deductible.
How Medicare covers a Hospital Echocardiogram
Medicare Part A covers hospitalization, including tests performed while you are an inpatient at a hospital. If, for example, you’re in the hospital after a heart attack and your doctor then orders an echocardiogram, it will fall under Medicare Part A.
Before Part A begins to pay, you must meet a deductible ($1364 in 2019). After that, Part A pays your costs for the first 60 days you are in the hospital. After day 60, you will pay a daily copay until your hospitalization benefits run out.
Medicare Part B Coverage for Other Echocardiograms
If you have an echocardiogram in your doctor’s office, at an outpatient center, or in the emergency room, it falls under Medicare Part B’s medical coverage. Medicare Part B works differently than Part A.
With part B, you are responsible for a small deductible each year ($185 in 2019). After you have met your deductible, Medicare will pay 80 percent of the cost of covered medical services. This includes echocardiograms.
An echocardiogram is a common test that uses high-frequency sound waves to create images of your heart. By watching the way your heart beats and pumps blood, your doctor can see how well your heart is working.
There are several types of echocardiograms:
- In a standard, or transthoracic, echocardiogram, a probe that produces sound waves goes over your chest. The sound waves bounce off your heart and back to the probe, where they become pictures your doctor views on a monitor.
- Your doctors may recommend a transesophageal echocardiogram if they need clearer or more detailed images than they can get from a standard echocardiogram. For this test, a probe goes down your throat and into your esophagus.
- A stress echocardiogram, also known as a stress test, is used to detect heart issues that only show up during physical activity. During this test, images of your heart will be taken immediately before and after you exercise on a treadmill or stationary bike. If you can’t exercise, you’ll receive medication to make your heart pump as though you were exercising.
Who Needs an Echocardiogram
Your doctor may order an echocardiogram to see if your heart valves are working properly, to find out if heart problems are causing your chest pains or shortness of breath, or to detect heart defects in a fetus. If Medically necessary, Medicare could cover an echocardiogram.
The test can show:
- How strongly your heart is pumping
- The size and shape of your heart and its chambers
- Heart defects
- The thickness of your heart walls
- Whether your heart valves are working the way they should
- Heart damage, such as damage from a heart attack
- Problems with the blood vessels that go to and from the heart
How Medicare Advantage Plans cover Echocardiograms
Medicare Advantage plans are Medicare replacement policies. The exact benefits will depend on the plan you have, but at a minimum, you’ll have the same echocardiogram benefits you’d have if you had traditional Medicare.
There is one important limitation though. Unlike traditional Medicare, Medicare Advantage plans use a network of doctors, and you will pay significantly more if you use a doctor or hospital that is not in your plan’s network.
Medicare Supplements Help Cover Echocardiograms
Medigap, or Medicare Supplement, plans, work alongside Medicare Parts A and B to help pay your Medicare deductibles and coinsurance.
A Medigap plan can dramatically reduce the amount you have to pay for echocardiograms and other common tests and procedures. There are 10 available plans, and the benefits vary by plan.
- Some plans pay the full 20 percent coinsurance amount under Part B
- All Medigap plans cover an additional 365 days in the hospital
- Some plans also pay the Part A and/or Part B deductible
When it comes to Medicare coverage, it pays to shop around. MedicareFAQ helps you find the best plan at the best rate. Let us give you a free quote on a top-rated insurance policy – just give us a call or fill out an online rate form.