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I believe it is once between the age of 35 and 40, and then yearly after that???????
Anybody????????
Physical examinations for FAA First Class medical certification require an electrocardiogram (a.k.a. ECG or EKG) on the first physical examination after age 35 and annually after age 40 - FAR Part 67.111 (b). Second and Third Class certification examinations do not require ECG’s.
https://aviationmedicine.com/articles/index.cfm?fuseaction=displayArticle&articleID=37
Does that add to the cost of the medical?