Medicare covers cardiac rehabilitation for certain qualifying conditions. The cardiac rehab program must also meet specific criteria.
Medicare covers cardiac rehabilitation that’s medically necessary. For example, this rehabilitation may be medically necessary if you’ve recently had a heart attack or undergone a surgical procedure for heart disease, such as a valve replacement, transplant, or stenting.
Cardiac rehabilitation programs provide:
- physical therapy
- education
- counseling
This article will outline the requirements for Medicare to cover cardiac rehab, as well as your estimated costs.
Medicare covers regular and intensive cardiac rehabilitation programs if they are medically necessary and you meet the eligibility guidelines.
The specific program must meet Medicare guidelines and be in a hospital outpatient department or a doctor’s office. You must be under the care of a doctor while at the facility.
The facility must also have cardiopulmonary emergency equipment available in case it’s needed.
Learn more about Medicare coverage for chronic heart disease management.
Medicare Part B covers cardiac rehabilitation if you have certain health conditions that require it, including:
- heart attack in the previous 12 months
- coronary artery bypass surgery
- stable angina (chest pain)
- heart valve repair or replacement
- coronary angioplasty to open a blocked artery or stenting to keep an artery open
- heart transplant
- heart-lung transplant
- stable chronic heart failure
How much you pay out of pocket for cardiac rehabilitation can depend on how many sessions you need. Medicare typically covers 36 sessions, which may be scheduled as 2 to 3 sessions per week for 12 to 18 weeks.
Outpatient cardiac rehabilitation costs
The cost of a session may vary by facility.
If you receive cardiac rehabilitation in a doctor’s office that is not part of a hospital, it is covered under Medicare Part B (medical insurance).
After you’ve paid your Part B deductible, which is $240 in 2024, you are responsible for 20% of the Medicare-approved amount for the service.
If you get cardiac rehab in an outpatient facility connected with a hospital, you may also have to pay a hospital copayment.
Make sure the facility or healthcare professional “accepts assignment,” which means they accept the Medicare-approved amount as the full cost. Otherwise, you may also have to pay the difference between what they charge and what Medicare pays.
If you have a Medicare Advantage (Part C) plan, your costs may vary according to your specific plan. You may also need to receive cardiac rehabilitation from an in-network healthcare professional.
Cardiac rehabilitation costs while admitted to a hospital
Cardiac rehab that you receive while admitted to a hospital is covered under Medicare Part A (hospital insurance).
You’ll need to pay your Part A deductible of $1,632 in 2024. After you’re discharged from the hospital, if you still need cardiac rehabilitation as an outpatient, you’ll be responsible for the above outpatient costs through Part B.
What qualifies someone for cardiac rehab?
You can qualify for cardiac rehab if you have certain heart conditions, such as stable chronic heart failure or a heart attack in the past 12 months, or if you undergo certain surgical procedures, such as valve repair or replacement or stenting.
What are six things that may be included in a cardiac rehabilitation program?
Complete cardiac rehabilitation programs
- nutritional counseling and weight management
- blood pressure and cholesterol management
- diabetes management, if applicable
- smoking cessation, if needed
- psychosocial education around managing medications, independent living and working, and counseling
- physical activity counseling and training
Does Medicare cover treatment for heart failure?
Medicare covers treatment for heart disease, including heart failure. Treatment may include necessary medications, procedures, doctor’s visits, cardiac rehab, and durable medical equipment you need at home.
Medicare covers treatment, including cardiac rehabilitation, when it’s medically necessary for your heart health.
For Medicare to consider the treatment medically necessary, you must have certain health conditions or must have undergone certain medical procedures. You must also receive cardiac rehabilitation at a facility that meets Medicare’s requirements.