Does Medicare Cover Electrocardiogram (EKG or ECG) Tests?
Commonly called an EKG or ECG, an electrocardiogram is a test to get a sense of how your heart is doing. Both EKG and ECG refer to the same medical exam—the only difference is that the word “electrocardiogram” is spelled with a “K” in certain parts of the world.
Medicare covers electrocardiograms if they are medically necessary to detect problems in your heart. In this post, we’ll let you know how you can receive coverage for an EKG or ECG and what your out-of-pocket costs may be for the exam.
Key takeaways:
Doctors use an electrocardiogram (EKG or ECG) to detect heart issues, like arrhythmias and heart attacks.
Medicare covers ECG screenings during your “Welcome to Medicare” visit, or as a diagnostic test if it’s considered medically necessary.
What is an electrocardiogram?
Your doctor may order an electrocardiogram if you have heart problems or you need to monitor your heart health. An ECG is a medical exam that records the electrical activity of your heart over a period of time. To perform an ECG, doctors attach small, adhesive patches called electrodes to your body. These electrodes sense and record electrical signals from your heart. The results of an electrocardiogram can be used to diagnose arrhythmias, previous heart attacks, and the cause of chest pains.
ECG machines come in different forms. You can find bigger machines in medical offices and health facilities or smaller, portable devices. Two types of portable ECGs are a Holter monitor and event monitor. A doctor may recommend that you wear these devices if your symptoms come and go and a regular ECG can’t find any irregularities in your heartbeat.
Electrocardiogram vs. Echocardiogram
It’s easy to confuse an electrocardiogram with an echocardiogram. While an echocardiogram is also a type of diagnostic tool to examine the heart, it uses sound waves to create images of your heart. Here’s a quick breakdown of the two types of tests and when doctors would recommend one over the other.
Electrocardiogram:
Measures electrical activity of the heart
Best for a quick, initial screening for symptoms related to heart conditions
Detects heart attack history and arrhythmias
Echocardiogram:
Uses ultrasound scan to create images of the heart’s structure and function
Best to provide detailed information about heart’s chambers, valves, pumping function, and blood flow
Detects heart valve disorders, congenital heart defects, heart muscle diseases, arrhythmias, and inflammation or fluid-buildup
If you have chronic heart problems, your doctor may order both an electrocardiogram and echocardiogram to assess your heart health. Medicare also covers an echocardiogram, and the guidelines for coverage are similar to those for an ECG.
Does Medicare cover EKG or ECG screenings?
Yes, Medicare covers routine electrocardiogram screenings. You can get coverage for the exam in two different ways:
If you get a referral from your doctor during your initial “Welcome to Medicare” visit
If the ECG is medically necessary
Since the “Welcome to Medicare” visit is a one-time appointment, you’re more likely to receive coverage if your doctor determines that the ECG is medically necessary. “Medically necessary” could mean you have symptoms of heart abnormalities like:
Chest pain or discomfort
Shortness of breath
Heart palpitations
Dizziness, fatigue, and fainting
Swelling in the legs, ankles, feet, or abdomen (peripheral edema)
People with heart disease, a family history of heart disease, high blood pressure, or diabetes may also need an ECG as a preventive measure. In these circumstances, the ECG would also be considered medically necessary.
Your out-of-pocket costs for an EKG or ECG with Medicare
Part B, or your outpatient medical insurance, is responsible for covering the cost of an ECG. Once you’ve met your Part B deductible, Medicare pays for 80% of the cost of the exam. This leaves you responsible for the remaining 20% (your coinsurance). A Medicare Supplement plan can help you reduce your out-of-pocket expenses.
Where you receive the test will also determine how much you’ll pay. If you get the ECG at a hospital or outpatient department of a hospital, you’ll pay a hospital copayment on top of the 20% Part B coinsurance. Ask your doctor for a recommendation for an outpatient facility to avoid a hospital copay.
Medicare Advantage plans will also cover an ECG, but they don’t have standardized payment structures. What you pay out of pocket for the exam will depend on your specific policy. Contact your insurance carrier or consult your summary of benefits to get an idea of what you would pay for an ECG.
Other screenings Medicare covers
Medicare covers a variety of preventive services so you can prioritize your wellbeing and stay healthy. If you have questions about your plan options or how Medicare coverage works, we’re here to help! Call us at 855-900-2427 or schedule a time to chat to get help from a licensed Medicare Advisor.