One of the most valuable diagnostic tools for physicians, an echocardiogram (also called an echo test or ECG), is an ultrasound of the heart. Sound waves bounce off the heart to produce real-time images of the organ as it beats and pumps blood through its chambers and into the body. Doctors use echocardiogram images to detect heart disease as they examine the heart valves and chambers.
Every year in the United States, 20 percent of people who are enrolled in Medicare receive an echocardiogram. With heart disease the number one cause of death in the U.S. for people 65 and over, having medical insurance coverage for this valuable test is priceless.
If your physician has recommended that you have an echocardiogram done, your Medicare insurance may cover the cost. You should have all the details about the test and your coverage before you make your decision to have one done.
What to Expect During an Echocardiogram
Known scientifically as a transthoracic echocardiogram, or echo test for short, it is a noninvasive exam and not harmful to the body. During an echocardiogram, or ultrasound of the heart, the doctor observes your heart as it is pumping blood and can see how your heart is functioning.
As the exam takes place, your physicians observe your heart’s chambers, the heart function, the strength of its beat, the size of the organ, and the amount of pressure exerted on the heart and valves.
Your doctors can see whether there is a leakage in the valves or if they are having difficulty opening. They may also be able to detect abnormalities like blood clots, fluid in the pericardium, or problems with the aorta. Using an echo test, doctors can also determine whether the heart’s muscle tissue has been damaged after a heart attack.
Your health care provider may order an echo test if you have any of the following symptoms:
• A heartbeat that is racing, fluttering, or irregular
• Shortness of breath or trouble breathing
• Chest pain or discomfort
• Swelling in the lower extremities
• If a heart murmur is detected, or if a known heart murmur becomes more serious
• Unusual fatigue
• Dizziness or fainting
You do not have to make any physical preparations before an echocardiogram. When you arrive at the clinic or doctor’s office, you put on a gown, lie down on the exam table, and the examiner puts gel on your chest and uses the wand of the ultrasound to get the best image.
How Medicare Helps Cover an Echocardiogram
Without Medicare coverage or other health insurance, an echocardiogram costs anywhere from $500.00 to $3,000.00 depending on the normal variables. Generally, these exams are more costly in larger cities. Across the United States, the average price for a standard echo test is $1,500.00.
You may have Medicare coverage for echocardiograms if you have an Medicare Part B. In order to be eligible for coverage, your health care provider must order the echocardiogram to gain information for treatment of a medical problem that you have, or that the physician suspects you have, and it must be deemed medically necessary. To be eligible for Medicare coverage, the health care provider doing the exam must accept Medicare assignment.
Part B generally covers 80 percent of the Medicare-approved cost of an echocardiogram. You pay 20 percent of that final approved amount. You are also responsible for your Part B deductible which is $185.00 as of 2019.
If you have a Medicare Advantage (Part C) plan, you will have the same Part A and Part B benefits as Original Medicare, and many will provide additional coverage at little to no extra cost. The final, Medicare-approved cost of your echocardiogram depends on where you live, where you have the test done, and what your physician charges.
Echocardiograms are painless exams that provide valuable information about your most vital organ – your heart. If you have questions or concerns about an echocardiogram or whether the cost is covered by your Medicare policy, your health care provider can give you the advice and information that is best for your situation.
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