Medicare and Heart Health

Medicare Part B covers both general cardiac rehabilitation and intensive cardiac rehabilitation (ICR) programs. These provide various services if you have a heart condition, including exercise, education, and counseling. These programs are designed to help improve your cardiac health and reduce risk factors.

How can I be eligible?

Medicare Part B will cover a cardiac rehabilitation program and the ICR programs if you were referred by your doctor and have had any of the following conditions or procedures:

Heart attack in the last 12 months
Coronary bypass surgery
Stable angina pectoris (chest pain or discomfort due to heart disease)
Heart valve repair or heart valve replacement
Coronary angioplasty or coronary stent (opening or widening of an artery)
Heart or combined heart-lung transplant
Stable chronic heart failure

It also covers ICR programs if your doctor prescribes the program and you have any of the conditions above except for stable chronic heart failure.

You can receive cardiac rehabilitation care in a hospital outpatient department or at a doctor’s office. Medicare will cover up to two one-hour sessions per day for up to 36 sessions. These sessions must occur during a 36-week period. If it is medically necessary, Medicare will cover an additional 36 sessions.

If you qualify for intensive rehabilitation services, Medicare will pay for up to six one-hour sessions per day for up to 72 sessions. These sessions must occur during an 18-week period.

All cardiac rehabilitation programs typically include:

Exercise
A program to reduce your cardiac risk factors (such as nutritional counseling and education)
Psychosocial assessment of your mental and emotional needs related to rehabilitation
Individualized treatment plan
Outcome assessment

How much will it cost?

Original Medicare's coverage on cardiac rehabilitation is up to 80% of the Medicare-approved amount. If you receive care from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible ($198 in 2020).

If you receive care in a hospital outpatient department, you pay a copayment that can be no more than the Part A hospital deductible ($1,408 in 2020).

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