Does Medicare cover an echocardiogram?
An echocardiogram is a type of medical exam that doctors use to check on your heart. Your healthcare provider may order a echocardiogram if you show symptoms of heart diseases, heart failure, congenital heart defects, or other abnormal heart behaviors.
Paying attention to your cardiovascular health becomes even more important as you age. Medicare covers any medically necessary echocardiogram, so you can prioritize your heart health.
Key takeaways:
Medicare covers an echocardiogram if the test is medically necessary to diagnose or monitor a heart condition. You’ll pay 20% of the cost of the echo if you’ve already met your Part B deductible.
Medicare Advantage plan out-of-pocket costs vary.. Check your summary of benefits or contact your insurance provider to understand your costs for an echocardiogram.
What is an echocardiogram?
If you’re experiencing issues with your heart, your doctor needs a way of seeing your heart. An echocardiogram is a test that uses sound waves to create images of your heart. During the test, a healthcare professional puts a handheld device on your chest. This device releases high-frequency sound waves (also called ultrasound waves) that bounce off of your heart. These “echoes” then convert into images that doctors can use to diagnose and monitor heart conditions.
If you’re experiencing constant dizziness, heart palpitations, chest pain, or other irregularities with your heart, your doctor may recommend an echocardiogram. Some things they may look for your echocardiogram are:
The size of your heart
How your heart valve functions
How your heart is pumping blood
Blood flow patterns
Inflammation or fluid build-up
Clots or tumors
Pressure of your arteries
Your heart’s response to stress
Heart murmurs or arrhythmias
With an echocardiogram, doctors can diagnose heart conditions, monitor how a disease progresses, and decide on the right treatment for your health condition.
How much does an echocardiogram cost?
Most medical exams and procedures are costly without insurance. This rings true for echocardiograms. The average cost of an echocardiogram without insurance is between $1,000 and $3,000. Let’s learn about how Medicare covers an echocardiogram so you don’t have to worry about paying that much.
Does Medicare cover an echocardiogram?
Yes, Medicare covers an echocardiogram when your doctor recommends the test to diagnose or monitor a heart condition. If you have Original Medicare, your Part B covers most of the costs of an echocardiogram.
Medicare Part B is your outpatient insurance, and it covers 80% of the Medicare-approved cost of the test. You’re responsible for the remaining 20% after you’ve met your Part B deductible.
Because echocardiograms are fairly expensive, your 20% copay or coinsurance could still be costly. Let’s say the test costs $2,000 at your healthcare facility. Medicare Part B would cover $1,600, and you’d pay the remaining $400. If you’re concerned about this leftover amount, a Medicare Supplement plan can help reduce your out-of-pocket costs.
Does Medicare Advantage cover an echocardiogram?
All Medicare Advantage plans cover the same services as Original Medicare, but Medicare Advantage policies have different cost structures and some come with limitations. This means that your out-of-pocket costs for an echocardiogram could vary with a Medicare Advantage plan. Your plan may also:
Require prior authorization for the test
Charge you more for an out-of-network provider
To make sure that you understand what you’ll pay for an echocardiogram with your Medicare Advantage plan, familiarize yourself with your summary of benefits. You can also get in touch with your insurance carrier to ask questions about how much you’ll likely pay for an echocardiogram.
Other heart-related Medicare coverage
Medicare covers a range of services for your heart health. See what else you can get covered below:
Cardiovascular disease screenings
Services to manage high blood pressure
Other medically necessary tests like electrocardiograms (EKGs), X-rays, and cardiac CT scans
Surgical implants and procedures for your heart
Medications to manage heart conditions
Like with an echocardiogram, you’ll still need to pay a coinsurance or copay for most of these services. If you’re at all concerned or confused about your Medicare coverage, you can talk to a licensed Medicare Advisor at Chapter. We’ll help you navigate your plan so you get the most out of your benefits. Call us today at 855-900-2427 or schedule an appointment.