An echocardiogram, or echo, is a test that uses sound waves to create a picture of the heart while in motion. The results show the shape and size of the heart and reveal how the heart valves and chambers are functioning. Medicare will usually cover the test if it is medically necessary and if the provider accepts Medicare assignment. Whether a person has original Medicare or Medicare Advantage, coverage for echos may involve out-of-pocket costs.
This includes coinsurance, copayments, and deductibles, all of which depend on various factors, such as the type of plan or the area of the country in which a person lives.
Echocardiograms also show:
- Blood clots within the heart as well as fluid accumulation in the sac around the heart
- Areas of the heart muscle that do not contract adequately due to poor blood flow or damage from an earlier heart attack
- Problems with the aorta, the primary artery that takes blood from the heart to all parts of the body
The Original Medicare is comprised of Part A and Part B. Part A covers your echocardiogram during a hospital stay, while Part B covers the test in an outpatient clinic.
Then you have Part C, which is also called Medicare Advantage. This is the alternative to the original Medicare. Medicare Advantage plans cover “echos” in an inpatient or outpatient setting. But to keep costs down, they may require a person to use in-network providers.
You can always purchase Medigap. Medigap is a Medicare supplemental insurance, which pays up to 100% of parts A and B out-of-pocket costs, including those for an echo. Medigap plans are available to those with original Medicare but not those with Medicare Advantage plans.
Medicare Part D centers around prescription drug coverage, so obviously, this program does not pertain to echocardiograms.
Here are the out-of-pocket costs for 2021, that could be associated with an echocardiogram in parts of Medicare.
If a person has an echo during a hospital stay, the costs for the tests and all other hospital services include:
- $1,484 deductible for each benefit period
- $0 coinsurance for days 1–60
- $371 coinsurance per day for days 61–90
- $742 coinsurance for each lifetime reserve day for days 91 and beyond
Getting an echo in an outpatient setting, one can expect these costs:
- $148.50 monthly premium
- $203 annual deductible
- 20% coinsurance
To illustrate, the average cost of an echocardiogram without insurance is $2,000.
The costs for Medicare Advantage plans include deductibles, copayments, coinsurance, and monthly premiums. All costs vary among the plans. Before having an echocardiogram, a person may wish to check with their plan provider to confirm the out-of-pocket expenses they may expect.