Does Medicare Cover an Echocardiogram

Original Medicare covers echocardiogram costs when it is medically necessary. Your doctor may order an echocardiogram to measure how well your heart pumps blood throughout your body.

In addition to an echocardiogram, Medicare will cover other medically necessary heart tests to help your doctor diagnose or check the progression of a heart-related issue. Below, we review guidelines, coverage, and common questions relating to Medicare coverage for echocardiograms and other heart-related tests.

What is an Echocardiogram?

An echocardiogram is a heart test that uses sound waves to create internal images of your heart. This standard test allows your medical provider to view your heart beating and pumping blood throughout your body.

There are two main types of echocardiograms. The type of echocardiogram you receive depends on the images your provider needs.

A transthoracic echocardiogram is the most common type. This test involves a sonographer using a device like an ultrasound machine to record live images of your heart and its valves.

A transesophageal echocardiogram involves a local anesthetic in your throat. Your provider will introduce a flexing tube down your esophagus to your stomach. This device then records images of your heart to an external monitor that your provider will view.

An echocardiogram creates images that allow your doctor to view or diagnose heart disease.

Does Medicare Cover a Routine Echocardiogram?

Medicare will only cover an echocardiogram when a practitioner deems it medically necessary. Echocardiograms are not part of your Medicare annual wellness visit and are not a preventative service. However, if your doctor requires you to have an echocardiogram due to a heart issue, you will receive Medicare coverage.

Echocardiogram vs EKG

An EKG or an electrocardiogram is a test that searches for abnormalities in your heart’s pulses through electrodes. Although the names are similar, an electrocardiogram (EKG) differs from an echocardiogram. Both are considered non-invasive cardiac testing. However, the results shown from the tests are different.
The chart below shows the differences between an echocardiogram and an EKG.

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.

Your doctor may perform your Welcome to Medicare EKG at the office or send you to an outpatient facility. Either way, Medicare Part B will pay a portion of the Medicare-approved rate for the procedure.

You must attend your Welcome to Medicare visit within the first 12 months you are on Medicare. Otherwise, Medicare will not pay for a routine EKG. To receive Medicare coverage for an EKG outside your Welcome to Medicare visit, your physician must deem the test medically necessary. 

Medicare Guidelines for a Diagnostic Echocardiogram and EKG

Medicare Part B will pay for unlimited outpatient diagnostic echocardiograms and EKGs. However, for Medicare to categorize the test as diagnostic, it must be medically necessary. Once you meet your Medicare Part B deductible, you will be responsible for 20% of your EKG or echocardiogram cost.

You may need an echocardiogram or EKG if you experience any of the following:

• Severe dizziness or lightheadedness
• Chest pain and/or shortness of breath
• 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 echocardiogram or EKG before you undergo surgery

An echocardiogram or EKG may diagnose:

• Heart disease
• Blood clots
• Atrial fibrillation
• Heart valve problems

Additionally, to receive Medicare coverage for an echocardiogram or EKG, you must receive care from a provider who accepts Medicare.

How to Lower Your Medicare Costs for an Echocardiogram

Additional Medicare coverage is essential for lowering your out-of-pocket medical costs. A Medicare Supplement plan may be your best option for keeping your expenses low over time.

A Medicare Supplement plan covers the out-of-pocket expenses for which you may otherwise be responsible. Therefore, these policies significantly reduce the total you owe for services.

Additionally, when you enroll in a Medicare Supplement plan, you do not need to worry about networks. If a provider accepts Original Medicare, they will also take your Medicare Supplement plan as payment, regardless of your carrier.

If a Medicare Supplement plan is not for you, a Medicare Advantage plan may be the best option. Medicare Advantage plans must cover the same services as Original Medicare.

However, the private insurance companies offering Medicare Advantage policies set the deductibles, copays, and coinsurance. So, you could end up paying more for your test than you would with a Medicare Supplement plan.

Additionally, to avoid unexpected bills, ensure the doctors administering your EKG are in your Medicare Advantage plan’s network. Either way, a Medicare Supplement or Medicare Advantage policy will cap your out-of-pocket costs, unlike Original Medicare. Thus, leaving you with fewer overall out-of-pocket costs.

Additional Heart Tests Covered by Medicare

In addition to echocardiograms and EKGs, Medicare will cover a variety of other heart tests to ensure your heart’s health. These tests include:

• Holter monitors
• Heart monitors
• Stress test
• Chest x-ray
• Coronary angiography
• Cardiac CT scan
• Cardiac catheterization

If your doctor deems any of the above tests medically necessary to diagnose, treat, or manage a heart-related issue, Medicare will cover their portion of the costs.

Medicare Coverage for Echocardiograms FAQs

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. Consequentially, this may mean several EKGs or echocardiograms. Medicare covers some of your costs, but caring for a heart condition can be costly.

A Medicare Supplement plan helps you avoid financial risk by paying all or part of the bill that Medicare leaves behind after paying your monthly premium. These policies leave you with little to no out-of-pocket costs.

At MedicareFAQ, we help you find the right Medicare Supplement plan for your healthcare needs and budget by performing a needs analysis and comparing all the top plans in your area. Call the number above or complete our online rate form for your free plan comparison today!

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