There are many different tests available to evaluate how well your heart is working. One of the most common tests is called an echocardiogram.
Your healthcare provider may order an echocardiogram to find out how well your heart is pumping blood and if there are any problems with how itâ€™s beating.
Usually, Medicare will cover an echocardiogram when a healthcare provider orders it for a medically necessary reason. Medicare should cover most, if not all, of the costs.
Next, weâ€™ll go over:
- the specifics of Medicare coverage
- any costs you can expect for this test
- why this test might be ordered for you
Does Medicare cover echocardiograms?
Each year, thousands of Medicare participants have an echocardiogram that their healthcare provider orders. The associated potential costs can be high, so how much does Medicare really cover?
Medicare Part A
Medicare Part A, which is your hospital insurance, will cover the cost of any tests your doctor orders during an inpatient stay in a hospital or skilled nursing facility.
Medicare Part B
Medicare Part B will generally cover all diagnostic outpatient tests, as long as theyâ€™re documented as being medically necessary.
Your doctor must order an echocardiogram for a condition thatâ€™s a Medicare- approved reason to have the test.
Medicare Advantage (Part C)
If you have a Medicare Advantage plan, it must cover at least as much of the cost as original Medicare. However, costs vary based on the type of plan you have.
Full coverage of echocardiogram associated costs may require you to see a provider whoâ€™s in your planâ€™s network.
Call your Medicare Advantage plan provider to verify all expenses that you will be responsible for before scheduling your test.
How much do echocardiograms cost with Medicare?
If your doctor states you need an echocardiogram for a medically necessary symptom or condition, it will be covered under Part A (inpatient), Part B (outpatient), or Part C (Medicare Advantage coverage).
Hereâ€™s a further breakdown of the costs for this test under each part:
- Medicare Part A. Part A will cover the costs of all services and procedures needed during an inpatient hospital stay, as long as they occur within the first 60 days of your admission. These services and procedures are included in the overall $1,408 deductible per benefit period.
- Medicare Part B. Part B will cover 80 percent of the Medicare-approved cost of the test, and youâ€™re responsible for the other 20 percent. If the echocardiogram is performed as an outpatient test at a hospital or a hospital-owned clinic, you may also have to pay the hospital a separate copayment amount. Check with the facility where youâ€™re having the echocardiogram so that you can anticipate any possible costs.
- Medicare Part C. If you have a Medicare Advantage plan, check with your plan for specific coverage and cost information. You can also search your planâ€™s directory to find in- network providers to help keep your costs down.
To put this in perspective, letâ€™s look at an example. The average out-of- pocket costs for an echocardiogram can be anywhere from $1,000 to $3,000 without insurance coverage.
Letâ€™s assume your medically necessary echocardiogram costs $1,500, and you have Medicare Part B coverage. Medicare will cover 80 percent of the cost, or $1,200. You would be responsible for covering the remaining $300.
You can check whether Medicare covers a certain lab test or procedure by searching the Medicare website here.
What are the rules and restrictions?
As with all other procedures and services that Medicare covers, there are some rules and restrictions to remember, such as:
- Your doctor or healthcare provider must document that the echocardiogram is medically necessary.
- You must see a doctor or healthcare provider whoâ€™s enrolled in Medicare and accepts assignment in order to receive full coverage benefits.
Itâ€™s very important to double check your doctorâ€™s participation in Medicare before having the echocardiogram done.
If they donâ€™t accept Medicare coverage, you may have to pay for the test out of pocket or pay any out-of-network charges. This is especially important if you have a Medicare Advantage plan.
You can find participating healthcare providers and facilities using Medicareâ€™s provider finder tool.
What is an echocardiogram?
An echocardiogram is an ultrasound of your heart. The test uses sound waves that bounce off your heart and its structures to provide a live image of how your heart is functioning. An echocardiogram may be used to assess:
- how well your heart valves are working
- how efficiently your heart is contracting (pumping) and relaxing
- if there are any blood clots present
- if there are any problems with the blood vessels around your heart
What can I expect to happen during an echocardiogram?
The most common type of echocardiogram is a transthoracic echocardiogram. This test is painless and relatively easy.
Itâ€™s performed while youâ€™re lying either on your side or your back, depending on what kind of pictures need to be taken.
An ultrasound technician will place some gel on your chest and hold a transducer over the area of your heart. The technician will move the transducer around to get different views of your heart.
Why might I need an echocardiogram?
Your doctor may order an echocardiogram if youâ€™re experiencing the following symptoms:
- dizziness or lightheadedness
- racing heartbeat
- irregular heartbeat or palpitations
- chest pain
- shortness of breath
An echocardiogram can diagnose many heart conditions, including:
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