Key takeaways

  • Original Medicare (parts A and B) or Medicare Advantage (Part C) usually covers echocardiograms (ECGs) when deemed medically necessary.
  • The median price of an ECG ranges from $204 to $2,588, with Medicare beneficiaries typically paying less than those with commercial insurance or no insurance.
  • Medicare Part A covers ECGs during inpatient care, Part B covers them for outpatient care after meeting the deductible, and Part C plans may require staying within a network for coverage.

Medicare covers any medically necessary diagnostic tests you need. This includes echocardiograms, also known as ECG. However, you may still have out-of-pocket costs.

Your exact coverage will depend on where you have the test and which Medicare part covers it.

Medicare will cover an echocardiogram when it’s deemed medically necessary as follows:

  • Part A: Part A (hospital insurance) will cover any tests your doctor orders during inpatient care, including an echocardiogram.
  • Part B: Part B covers outpatient care, so if your healthcare professional recommends an echocardiogram during your one-time “Welcome to Medicare” preventive visit, Part B will cover it. If you’ve already had this visit, Part B will only cover the test when considered medically necessary, such as if you’re experiencing chest pain, for example
  • Part C: If you have a Medicare Advantage (Part C) plan, it will cover an echocardiogram the same as Original Medicare. Some plans may cover the test under additional indications.

According to a 2022 study of U.S. hospitals, the median price of an echocardiogram ranged from $204 to $2,588. In addition, another 2023 study found that people who paid for the test without insurance or with coverage from commercial insurance paid 2.93 and 3.06 times more, respectively, than those covered by Medicare.

That said, your costs under Medicare for an echocardiogram depend on which part or plan provides the coverage as follows:

  • Part A: The cost of an echocardiogram will go toward your Part A deductible, which in 2025 is $1,676 for each benefit period. Once you meet it, Part A will fully cover all tests and procedures during your stay during the first 60 days of hospitalization.
  • Part B: After you meet your $257 deductible, Medicare will pay 80% of the approved cost of your echocardiogram. You’ll be responsible for paying the rest.
  • Part C: You often must see a provider in your plan’s network to get full coverage. In addition, the deductible and premium depend on your plan.

Medigap

Medigap is supplemental insurance that can cover your out-of-pocket costs from Original Medicare. This includes your Part A or B deductibles, copays, and coinsurance.

That means Medigap can help you pay the echocardiogram-associated costs you would typically pay out of pocket.

Medigap plans have a monthly premium on top of your Part A or B premium. So, while you’ll pay more each month, Medigap will cover these costs when you need a service like an echocardiogram.

Sometimes, your healthcare professional may need to obtain Medicare approval to provide a certain service, regardless of whether it’s medically necessary. This is known as prior authorization.

Although you typically do not need prior authorization for an echocardiogram covered by Parts A or B, some Medicare Advantage plans may require it. It depends on the insurance company that provides your Part C plan.

In any case, you’ll generally need to get your echocardiogram at a facility that accepts Medicare. The doctor or other healthcare professional performing the echocardiogram must also participate in Medicare.

You can search for eligible providers using the Medicare website. If they don’t accept Medicare, you may have to pay the full cost out of pocket.

Part C plans may also distinguish between in-network and out-of-network care. Sometimes, you won’t have out-of-network coverage, even if the facility participates in Medicare.

You’ll pay a higher out-of-pocket cost for out-of-network care.

Part A will cover your echocardiogram if you have it during an inpatient hospital stay, and Part B will cover it when you have it as an outpatient. Part C will also cover an echocardiogram, but you’ll typically need to stay within your plan’s network.

If Medicare doesn’t cover your echocardiogram, even though you think it should, you can file an appeal. An appeal allows you to explain why the echocardiogram was medically necessary.