Medicare Cardiac Rehabilitation Coverage

Medicare has covered cardiac rehabilitation since 1982. Another name for cardiac rehabilitation is Phase II rehabilitation. This rehabilitation type can help you engage in physical activity while medical professionals monitor your heart rate and rhythm and also involves counseling and education on heart health. ^[i]

Keep reading to find out what Medicare will cover in respect to cardiac rehabilitation if you have had heart surgery or a qualifying heart condition.

Medicare covers cardiac rehabilitation for persons who have a heart-related condition that is likely to benefit from this service. Examples include after a person has had 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:

You can ask the potential rehabilitation center for an estimate of how much cardiac rehabilitation will cost. Although the costs can vary slightly, having an estimate can help you to budget.

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.

If a doctor believes a patient can benefit from longer rehabilitation, they can write a “prescription” to attend cardiac 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 found that an estimated 366,000 Medicare participants could have qualified for cardiac rehabilitation in 2016, yet only about 25 percent of Medicare enrollees participated in cardiac rehab. ^[i]

Having more people ask their doctor about cardiac rehab and getting a referral to a program can help increase these numbers.

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 ^[i]

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.

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. ^[i]

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.

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.

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.