Does Medicare Cover Echocardiograms?
- Does Medicare cover echocardiograms? Learn what Medicare covers when it comes to these tests and understand what your out-of-pocket costs are likely to be.
An echocardiogram is one of several tests a physician can order to assess how well your heart is working. If you are a Medicare enrollee, you may ask yourself, "Does Medicare cover echocardiograms?" Read on to discover the details regarding Medicare and echocardiograms, as well as other heart-related procedures, including the costs involved.
What Is an Echocardiogram?
An echocardiogram is a noninvasive test that essentially is an ultrasound of your heart. It creates a live image of your heart's functioning by bouncing sound waves off your heart as it beats.
Doctors may prescribe an echocardiogram if you've shown symptoms such as:
- A heart murmur
- Chest pain
- An irregular, fluttering or overly fast heartbeat
- Dizziness or fainting
- Difficulty breathing or shortness of breath
- Extreme fatigue
- Swelling in your lower legs
The echocardiogram reveals how your heart's chambers and valves are functioning. It reveals any areas that aren't contracting properly, any blood clots present, problems with the aorta or other blood vessels, and fluid accumulation. Doctors can also use an echocardiogram to determine whether valves are leaking or not opening properly, and they can assess damage to heart tissue after a heart attack.
An echocardiogram is a fairly simple procedure to undergo. The ultrasound technician will ask you to change into a hospital gown and lie down on your side or back on an exam table. Then, they will place some gel on your chest and run the transducer, which is an ultrasound wand, over the area, recording the images for the doctor's review.
Does Medicare Cover Echocardiograms?
In most cases, Medicare does cover most of the costs of echocardiograms when they're ordered by a doctor who accepts Medicare. To be covered, the echocardiogram must be requested for a medically necessary reason that's approved by Medicare.
If the echocardiogram is ordered while you're in a hospital or skilled nursing facility, it's covered by Medicare Part A. If it's ordered as an outpatient test, Medicare Part B covers it.
If you're a participant in a Medicare Advantage plan (Medicare Part C), the coverage of an echocardiogram may depend on the type of plan you're enrolled in. More costs will be covered if you see a provider who's within your plan's network.
How Much Should an Echocardiogram Cost (and How Much Will Medicare Pay?)
Without Medicare or other health insurance coverage, an echocardiogram can cost anywhere from $1,000 to $3,000. Does Medicare cover echocardiograms? Yes, but your out-of-pocket cost depends in part on whether you've paid your deductible for the benefit period.
Under Medicare Part A, if the echocardiogram is ordered while you're in the hospital, your deductible is $1,484 per benefit period, which begins the day you're admitted to the hospital. If you have already paid that deductible, you will not have to pay anything additional for the echocardiogram if it's administered during your first 60 days in the hospital. Additional copayments are required after day 60 as an inpatient.
If you have the echocardiogram as an outpatient, Medicare will cover 80% of the cost of the procedure. For example, if the echocardiogram costs $2,000, Medicare will pay $1,600 for that bill. You are responsible for the $400 copayment remaining. In addition, if you haven't yet paid your $203 annual deductible, your total bill could rise as high as $603. If you have purchased Medigap coverage, it should cover at least some of your responsibility.
If you have a Medicare Advantage plan, you should check with your specific plan regarding your deductible and copayment obligations, as each Medicare Advantage plan is different. The amount that Medicare will pay depends on your location, the charges assessed by your physician and the plan. Using an in-network provider should help minimize costs.
Make sure that your doctor and the testing facility accept Medicare before you have the echocardiogram. If they don't accept Medicare, you may end up having to pay out-of-network charges or even for the entire procedure.
What Other Heart-related Tests Does Medicare Cover?
An echocardiogram isn't the only heart procedure or test that Medicare covers. In all cases, the same rules regarding deductibles and copayments apply, and tests must be medically necessary and ordered by a physician who takes Medicare. Here are some of the common heart tests that Medicare should cover:
- Cardiac CT scan. Doctors order this test to help detect aorta problems, coronary artery disease and arterial calcium accumulations.
- Chest X-ray. This simple X-ray test shows the heart, lungs and blood vessels, and it can provide evidence of lung disorders and heart failure.
- Cardiac catheterization. In this test, a tube is threaded through the body and into the heart to help diagnose and treat various heart conditions.
- Stress test. This test, which often employs an echocardiogram, lets doctors see how the heart works under physical stress. It's used to diagnose coronary artery disease and problems with the heart valves.
- Cardiac MRI. Used to diagnose heart tumors and heart valve problems, this test uses the magnets and radio waves of an MRI (magnetic resonance imaging) to create detailed pictures of the heart.
- Electrocardiogram. Often known as an ECG or EKG, this test checks the heart's rhythm and the electrical signals that control heartbeat. It's used to check for atrial fibrillation and other abnormal heart rhythms, as well as a heart attack.
- Coronary angiography. This test examines the insides of arteries to check for the buildup of plaque.
To learn specifics of whether a test or procedure is covered, check with Medicare here.