Older adults who suffer from heart conditions or have recently undergone heart surgery may be curious to know whether Medicare provides any coverage for cardiac rehab.
Medicare does cover cardiac rehabilitation. In this guide, we outline how Medicare might cover your cardiac rehab, how much it might cost and what your coverage options may include.
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Medicare will cover cardiac rehab if you have at least one of the following conditions.
Cardiac rehab provides services are designed to help those with heart conditions or recent heart surgeries with the education, counseling and exercise needed to manage their condition or recover from surgery.
Cardiac rehab is typically done on an outpatient basis in a hospital setting and is performed by either a specialized rehab team or your own doctor.
Medicare covers 36 sessions of cardiac rehab, with each covered session lasting two hours. If it’s deemed medically necessary to do so, Medicare might cover an additional 36 sessions.
Medicare may also cover more intensive cardiac rehab sessions. These are covered in one-hour sessions totaling up to 72 total sessions over an 18-week period.
Cardiac rehab is covered by Medicare Part B and all Medicare Advantage (Medicare Part C) plans.
Medicare Part B covers outpatient care, which is how cardiac rehab is typically administered. Medicare Advantage, or Medicare Part C, is required by law to cover everything included in Part B and Part A. Therefore, any Medicare Advantage plan from any insurance carrier will cover cardiac rehab the same way Original Medicare would.
When you use Medicare Part B to cover cardiac rehab, you will be responsible for a 20% coinsurance payment of the Medicare-approved amount. This is the amount that Medicare has pre-determined it will pay for the service, and the exact cost may vary from one part of the country to another.
The annual Part B deductible applies, so you must first satisfy this deductible before the coinsurance takes effect. The Part B deductible in 2023 is $226 per year.
If the health care provider performing the cardiac rehab does not accept Medicare assignment, they may be able to charge you up to 15% more than the Medicare-approved amount for the service. This is known as an “excess charge.”
If you have a Medicare Advantage plan, your plan deductibles and coinsurance or copayment requirements may vary, so you should be sure to check with your insurance carrier or plan provider. All Medicare Advantage plans are required to include an annual out-of-pocket spending limit, which means you can have some protection from potentially high costs of extended rehab.
The amount of coverage you receive may depend on whether you see an in-network or out-of-network provider for your cardiac rehab, depending on your plan’s network restrictions.
Learn more about how a Medicare Advantage plan may cover your cardiac rehab, and find plans that may offer benefits not found in Original Medicare.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.