Does Medicare Cover Cardiac Rehabilitation?

Medicare Part B medical insurance covers most of the cost of cardiac rehabilitation programs — also called cardiac rehab — if you have had certain specific conditions or prior procedures.

Medicare will also cover intensive cardiac rehab programs, which are more rigorous than standard cardiac rehabilitation.

Any cardiac rehab program must take place in a doctor’s office or a hospital outpatient setting in order for Medicare to cover part or all of the cost.

Medicare Advantage plans are required by law to cover everything covered by Original Medicare — Medicare Part A and Part B — so these plans will also cover cardiac rehabilitation.

If you are enrolled in Medicare Part B, Original Medicare will pay 80 percent of the cost of cardiac rehab if you receive the services in a doctor’s office. You will be responsible for 20 percent of the Medicare-approved cost after you have paid your Part B deductible.

If you receive cardiac rehabilitation in a hospital outpatient setting, you will be responsible for your Medicare Part B deductible and the hospital’s copayment amount.

If you have a Medicare Advantage plan, you should check with your plan’s administrator about the specifics of your coverage. Your plan may require you to use a cardiac rehab program from a specific health care provider in your network.

Cardiac rehabilitation is a comprehensive, medically supervised program that includes exercise education and counseling to improve your cardiovascular health after you’ve experienced a major cardiac event or heart surgery.

You’ll be asked to take tests before, during and after your series of sessions that measure different aspects of your heart health and rehabilitation progress.

Whether you receive your cardiac rehab in a doctor’s office or a hospital outpatient setting, the facility and staff have to meet certain requirements.

The facility must have medically accepted cardiopulmonary, emergency, diagnostic and therapeutic life-saving equipment. This includes devices and supplies such as CPR equipment, oxygen or defibrillators.

The staff must also monitor your heart rate, pulse, breathing and other vital signs during your exercise program. This information helps to monitor your condition while you’re working out and can give your doctor an idea of your condition and progress.

In order for Medicare to provide coverage, you will have to complete all cardiac rehab sessions within a 36-week period.

You will typically attend two to three sessions per week for 12 to 18 weeks. If your doctor determines that additional sessions are medically necessary, your coverage may be extended, but you can’t exceed 72 sessions in 36 weeks.

Your doctor may advise you to keep up with your cardiac rehabilitation routine after Medicare coverage ends. You can work with your doctor on an exercise program that fits your needs.