Two diagnostic tests, EKG and ECG, help detect issues you may be having with your heart. Medicare coverage depends on a variety of factors.
An EKG is a common medical procedure that helps your healthcare provider ensure your heart is functioning as it should. As we get older, it becomes ever more important to make sure our heart is healthy and acting properly. Here, we will discuss what an EKG is and how Medicare covers the process.
What is an EKG?
An electrocardiogram, commonly known as an EKG or ECG, is a painless procedure that records the electrical signals of your heart to make sure that it is functioning properly. EKGs are a noninvasive way to detect a variety of heart problems. Not to be confused with an echocardiogram, or echo test, which is an ultrasound of the heart. Both, however, give your physician a better understanding of how your heart is working.
Your doctor may order an electrocardiogram to monitor your overall heart health and detect any issues, such as abnormal rhythm or whether a pacemaker is working. Electrodes are attached to the chest to read electrical signals.
Echocardiograms use a wand to produce an image of the heart and show how it is pumping and whether there are issues with any of the chambers or valves. These are generally recommended for chest discomfort, shortness of breath, or swelling in the legs.
Does Medicare cover an EKG?
Original Medicare (Part A and Part B) covers EKGs through Part B under different circumstances:
- Your doctor has referred you for an EKG screening following your "Welcome to Medicare" exam
- Your doctor has referred you for an EKG screening as a medically necessary diagnostic test
You need to have a referral from your doctor, and it must be considered medically necessary to be covered. Once you've met your Part B deductible ($240 in 2024), you pay 20% of the Medicare-approved costs. You may also have a copayment depending on where the test is done.
Why would your doctor recommend an EKG?
If your doctor orders an EKG, it is likely because you are experiencing one or multiple of the following symptoms:
- Chest pain
- Heart palpitations
- Inability or decline in ability to exercise
- Rapid heartbeat
- Shortness of breath
An EKG can detect heart disease, previous heart attacks, and even heart attacks currently happening. It can also find any arrhythmia (irregular heartbeat), congenital defects, and inflammation.
Because the procedure is noninvasive, there is not much you need to do to prepare yourself for an electrocardiogram. You can eat, drink, and continue to take your medications as normal. Just be sure to notify your doctor of any medications you are currently taking before the procedure. The test is typically done in a hospital or doctor's office and electrodes (sticky patches with wires connected to the heart monitor) are attached to your chest. Your heart's signals are recorded through the electrodes and show the beats as waves; the whole process only takes a few minutes.
Does Medicare Advantage cover an EKG?
Medicare Advantage plans, also known as Medicare Part C, are legally required to have the same base coverage as Original Medicare. However, most Advantage plans come with additional benefits.
Private insurers sell Medicare Advantage plans, so costs and benefits vary depending on the specific plan you have.
What about Medigap?
Medicare Supplement Insurance, more commonly known as Medigap, helps cover your share of Medicare costs. However, these plans only help pay for services covered by Medicare. So, if Medicare covers the EKG, your Medigap plan should help. How much it pays depends on which Supplement plan you choose.
You can compare Medigap, Medicare Advantage, and Medicare Part D plans by entering your zip code into our Find a Plan tool. There you'll see the benefits and costs of Medicare plans in your area. Or call us toll-free at 888-992-0738 and one of our licensed agents will answer your Medicare questions and help you find the right coverage for you.
Other heart tests covered by Medicare
Beyond EKGs and echo tests, there are other medically necessary heart tests covered by Medicare Part B, some of which include:
- Cardiac catheterization: A more invasive procedure wherein a small tube is threaded to the heart from another part of the body. It is used to diagnose and treat different heart conditions.
- Cardiac MRI: Another imaging test, this procedure generates an image of your heart that shows heart conditions so your doctor can diagnose and create a treatment plan.
- Chest X-ray: This procedure is used to diagnose heart and lung issues, taking a picture of the blood vessels in the chest, the heart, and the lungs.
- Stress tests: These show how your heart works during physical activity and can diagnose coronary artery disease and heart failure.
As with an EKG, you pay 20% of the Medicare-approved cost once you've met your Part B deductible. Any test administered as part of an inpatient hospital stay would be covered under Medicare Part A, so you would then have to meet your Part A deductible instead.