Medicare Cardiac Rehabilitation Coverage
Key Takeaways
- Medicare covers cardiac rehabilitation under Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. .
- You will have to pay a copaymentA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. once you have met your Part B deductibleA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. .
- A doctor must diagnose you with certain heart conditions known to benefit from cardiac rehabilitation.
- Medicare may limit the amount of weeks or visits to 36 sessions initially.
Medicare Part B has covered outpatient cardiac rehabilitation, known as Phase 2 rehabilitation, since 1982. In these programs, you engage in physical activity while medical professionals monitor your heart rate and rhythm and also undergo heart health counseling and education.
Let’s look at some of the services Medicare will cover after heart surgery or if you have a qualifying heart condition.
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Does Medicare Cover Cardiac Rehabilitation?
Medicare covers cardiac rehabilitation for patients who have a heart-related condition that is likely to benefit from this service. Examples include after a surgery, such as cardiac bypass or a heart valve replacement.
Hospitals and medical facilities may offer cardiac rehabilitation at varying levels of intensity. Examples include intensive, inpatient rehabilitation as well as at a doctor’s office or at a hospital outpatient setting. As long as a person qualifies under Medicare, their Medicare plan will cover cardiac rehabilitation.
The costs under Medicare often depend upon where you are participating in cardiac rehab. The Part B deductible will apply. These costs include:
Part B Costs for Cardiac Rehabilitation
What You’ll Pay
Doctor’s Office
- 20 percent of the Medicare-approved amount
Hospital Outpatient Setting
- Copayment for hospital
Intensive Inpatient Program
- Facility copayment
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You can ask a facility for an estimate of how much cardiac rehabilitation will cost. Although the costs can vary slightly, having an estimate will help you to budget.
How Long Does Medicare Pay for Cardiac Rehab?
Medicare will pay for cardiac rehab for up to 36 sessions. Typically, a person will participate in rehabilitation sessions two to three times a week for a 12- to 18-week period.
A doctor may recommend that a patient continues rehabilitation for longer than 18 weeks. However, Medicare does not typically cover cardiac rehabilitation beyond 72 sessions over the course of 36 weeks.
How Many People With Medicare Participate in Cardiac Rehab?
Although cardiac rehab has been shown to help patients manage stress and enhance their health, there are still many people with Medicare who don’t participate in cardiac rehab. A study from the American Heart Association’s journal estimated that 366,000 people on Medicare could have qualified for cardiac rehabilitation in 2016, yet only about 25 percent participated in cardiac rehab programs.
What Diagnosis Qualifies for Cardiac Rehab?
Medicare will cover the costs of cardiac rehabilitation, providing you have a certain medical diagnosis. These include:
- Having had a heart attack in the past 12 months.
- History of coronary artery bypass surgery
- Currently stable angina (chest pain)
- History of a heart valve repair or replacement
- History of coronary angioplasty to open a blocked artery or place a stent
- History of a heart or heart-lung transplant
- Stable, chronic heart failure
Medicare doesn’t cover cardiac rehab for all medical conditions, just conditions where research has shown that cardiac rehabilitation is beneficial. For example, Medicare does not cover cardiac rehabilitation for patients with congestive heart failure.
When Do I Start a Cardiac Rehabilitation Program?
If you’ve been in the hospital for a heart-related issue (such as a heart attack or chest pain), your doctor will usually recommend waiting about one to three weeks after you get out of the hospital before you begin cardiac rehab.
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Does Insurance Cover Cardiac Rehab?
Private insurance plans, as well as Medicaid, will typically cover cardiac rehabilitation if you have a qualifying diagnosis. If you have a Medicare Advantage plan, the plan will cover cardiac rehabilitation. Medicare requires all Medicare Advantage plans cover at least the same benefits as Original Medicare. However, the copayments or deductible will depend upon your plan.
For private insurance, the required copayments or deductibles may vary based on a person’s insurance policy. If your doctor recommends cardiac rehabilitation and you have private insurance in addition to Medicare, you should talk to your insurance company about potential costs.
What Kind of Exercises Do You Do in Cardiac Rehab?
Cardiac rehabilitation is usually a combination of services, which may include medical evaluation, exercise, counseling, and education on heart healthy habits. One of the main differences between cardiac rehabilitation and traditional exercise is that during cardiac rehabilitation, a person will often wear a monitor that monitors their heart rate and rhythm (known as electrocardiographic monitoring). This can help trained personnel identify if a person’s heart may be too taxed with physical activity.
In addition, Medicare requires cardiac rehabilitation programs to have certain equipment. This includes life-saving equipment should an incident occur. Examples include oxygen, an automated external defibrillator (AED) or necessary equipment to perform cardiopulmonary resuscitation (CPR). Also, cardiac rehabilitation staff must be specially trained in basic and advanced life support.
The exercises in cardiac rehabilitation will vary based on your overall health and exercise tolerance. They may include aerobic activity, such as walking on a treadmill, riding a stationary bicycle, or using an elliptical machine. A person may also engage in muscle-building activity, such as weightlifting or using elastic exercise bands.
Is Cardiac Rehab the Same Thing as Physical Therapy?
Both cardiac rehab and physical therapy help a person recover from a health challenge or setback. However, cardiac rehab is usually staffed by nursing professionals while physical therapists provide physical therapy. Also, physical therapy usually doesn’t incorporate the monitoring of the heart’s tracing and blood pressure during therapy sessions.
Can You Do Cardiac Rehab at Home?
Cardiac rehabilitation is based on the idea that you can exercise while being monitored by medical professionals. A rehabilitation facility also has resources that could help resuscitate a person if they start having problems breathing or with their heart function when they exercise.
While you can exercise at home if you have a heart condition, you would not have the medical support you would otherwise have with cardiac rehabilitation.
However, there are some elements of cardiac rehab that you could do at home, such as through videoconferencing. Examples include counseling regarding heart-healthy habits, such as eating a healthy diet, quitting smoking, and reducing stress whenever possible. These elements of wellness can enhance your overall heart health.
Sources
- Just 1 in 4 Medicare recipients participate in cardiac rehab. American Heart Association.
- Cardiac rehabilitation. Medicare.gov.
- How Cardiac Rehabilitation Can Help Heal Your Heart. CDC.gov.
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