Keeping your heart healthy is key to enjoying a long and active retirement. Finding a Medicare cardiologist can help you prevent and manage heart disease while controlling costs.
But you may be wondering: How much does Medicare cover when you visit a cardiologist? Let’s find out.
Does Medicare cover cardiology visits?
Yes, Medicare covers a cardiology visit as long as the doctor provides medically reasonable and necessary services. Like other outpatient visits, services during a cardiology appointment are covered by Medicare Part B (medical insurance).
The annual Part B deductible is $233. After meeting the deductible, you typically pay 20 percent of the Medicare-approved amount for most services. The total you pay out-of-pocket will depend on how much you’ve paid toward the deductible and the nature of your visit.
Most cardiologists accept Medicare, but doctors who don’t participate in the program aren’t bound by approved cost, and you have to pay the full amount for any service you receive.
What does a Medicare cardiologist appointment cost?
The Medicare-approved amount for a cardiology visit depends on several factors, including where you live and the services you receive.
Let’s say it’s your first appointment with a cardiologist. The cost of a visit with a new patient in a doctor’s office is roughly $114. If you haven’t met your Part B deductible, you pay the full amount. If you have met the deductible, you pay 20 percent or just under $23.
Does Medicare cover a cardiac stress test?
A cardiac stress test can help a doctor to determine how well a patient’s heart functions. During a stress test, the doctor monitors a patient’s heart during exercise or, when that’s not possible, by simulating the effects of exercise with medication.
But Medicare doesn’t cover this kind of test for every patient.
Medicare only covers a cardiac stress test when the test is medically reasonable and necessary. This includes patients who:
- Have signs or symptoms of coronary artery disease.
- Have a disorder, such as diabetes, that can cause coronary artery disease.
- Have an abnormal electrocardiogram consistent with coronary artery disease.
Medicare does not cover cardiac stress testing when:
- A patient doesn’t have signs or symptoms of coronary artery disease.
- The information from a repeat test is not clinically relevant.
- The results of the test won’t affect treatment.
- The test is performed too frequently.
- A secondary condition will decrease the usefulness of the test.
In addition to a cardiac stress test, Medicare covers a stress echocardiogram and radionuclide imaging when those tests are medically reasonable and necessary.
What is the Medicare-approved amount for an echocardiogram?
An echocardiogram uses high-frequency sound waves to produce a real-time picture of the heart as it pumps blood. There are various types of echocardiograms, and the cost depends on the exact procedure and where you live, but the ballpark Medicare-approved amount is $230.
What you pay out of pocket for an outpatient test depends on how much you’ve already paid toward the Part B deductible. After hitting the deductible, Medicare covers 80 percent of the Medicare-approved amount, while you pay the rest.
What if I need cardiac rehabilitation?
If you’ve had a heart attack or have heart failure or other cardiac problems, a doctor may put you on a cardiac rehabilitation program that includes exercise, education and counseling.
Part B covers intensive or regular cardiac rehabilitation, if you’ve had one of the following:
- A heart attack in the last 12 months
- Coronary artery bypass surgery
- Current stable angina (chest pain)
- Heart valve repair or replacement
- Coronary angioplasty or coronary stent
- Heart or heart-lung transplant
- Stable chronic heart failure
After meeting your Part B deductible, you pay 20 percent of the cost. A copayment also applies if you get rehabilitation services in a hospital outpatient setting.
Which Medicare cardiology services are free of charge?
Medicare Part B covers a few heart-related services at no charge to you, including certain screenings.
Screenings
Part B covers a cardiovascular disease screening once every 5 years at no cost to you. These screenings include blood tests for cholesterol, lipids and triglycerides.
Cardiovascular behavioral therapy
Part B covers cardiovascular behavioral therapy once a year with your doctor free of charge. During the visit, your doctor will check your blood pressure, share healthy diet tips and may discuss aspirin use.
Abdominal aortic aneurysm screening
Part B covers one abdominal aortic ultrasound in a lifetime for patients with the following risk factors:
- Family history of abdominal aortic aneurysms
- Men ages 65 to 75 who have smoked at least 100 cigarettes
There is no charge for the screening when your doctor accepts assignment, meaning they agree to be paid the Medicare-approved amount directly by Medicare, but you need a referral to be screened.
What if I need help finding a Medicare cardiologist near me?
Primary care doctors help their patients manage their health, including chronic cardiovascular diseases, such as high blood pressure or high cholesterol. When you need more specialized heart care, your primary care doctor can help you connect with a cardiologist.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality primary care doctor near you. Our partner providers practice value-based care, meaning Medicare rewards them for helping patients get better, rather than the number of patients they treat.
A value-based care doctor will take the time to get to know you and your unique needs. You can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
