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Does Medicare Cover Pulmonary Rehab?
If you have moderate to very severe chronic obstructive pulmonary disease (COPD), Medicare Part B will cover most of the costs for pulmonary rehab.
Pulmonary rehab is a broad-based, outpatient program that combines education with exercises and peer support. During pulmonary rehab, you will learn more about COPD and lung function. You will also learn exercises designed to help you gain strength and breathe more efficiently.
Peer support is a significant part of pulmonary rehab. Participating in group classes offers an opportunity to connect with and learn from other people who share your condition.
A pulmonary rehabilitation program can make a significant difference in quality of life for people with COPD.Read on to learn more about what Medicare covers, how to qualify for coverage, and more.
Medicare coverage for pulmonary rehab
Medicare recipients are covered for outpatient pulmonary rehabilitation services through Medicare Part B. To be eligible, you must have a referral from the doctor who is treating your COPD. You can access pulmonary rehab services in your doctor’s office, freestanding clinic, or in a hospital outpatient facility.
If you have a Medicare Advantage (Medicare Part C) plan, your coverage for pulmonary rehab will be at least equal to what you would get with original Medicare. However, your costs may be different, depending on the plan you have. You may also be required to use specific doctors or facilities within your plan’s network.
Medicare typically covers up to 36 pulmonary rehab sessions. However, your doctor may be able to request coverage for up to 72 sessions if they are deemed medically necessary for your care.
What requirements do I need to meet for coverage?
To be eligible for coverage of pulmonary rehab, you must first be enrolled in original Medicare (parts A and B) and be up to date on your premium payments. You may also be enrolled in a Medicare Advantage (Part C) plan.
The doctor who is treating you for COPD must refer you for pulmonary rehab and state that these services are necessary to treat your condition.
To gauge how severe your COPD is, your doctor will determine your GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage. The COPD GOLD staging levels are:
- stage 1 (very mild)
- stage 2 (moderate)
- stage 3 (severe)
- stage 4 (very severe)
Medicare considers you eligible for pulmonary rehab if your COPD is stage 2 through stage 4.
To receive maximum coverage, make sure your doctor and the rehab facility accept Medicare assignment. You can use this tool to look for a Medicare-approved doctor or facility near you.
What costs should I expect?
Medicare Part B
With Medicare Part B, you’ll pay an annual deductible of $198, as well as a monthly premium. In 2020, most people pay $144.60 per month for Part B.
Once you’ve met the Part B deductible, you are only responsible for 20% of the Medicare-approved costs for your pulmonary rehab. Services you receive in a hospital outpatient setting may also require a copayment to the hospital for each of rehab session you attend.
In some instances, your doctor may recommend that you have more rehab sessions than Medicare is willing to pay for. If so, you may incur the entire cost of the extra sessions.
Medicare Part C
If you have a Medicare Advantage plan, your rates for deductibles, copays and premiums may be different. Contact your plan directly to find out how much you will be billed for these services so that you aren’t surprised later.
Medigap
Medigap (Medicare supplement) plans may cover some of the out-of-pocket costs from original Medicare. If you have a chronic condition, Medigap may be beneficial to keep your out-of-pocket costs down. You can compare Medigap plans to find one that works best for your situation.
Is pulmonary rehab right for me?
COPD is group of chronic, progressive lung diseases. The most common diseases that fall under COPD include chronic bronchitis and emphysema.
Pulmonary rehab has many benefits and can help you learn to manage your COPD symptoms. It can also help you make lifestyle changes to reduce your symptoms or possibly slow disease progression.
These rehab programs are meant to improve the quality of life and independence of those living with COPD. They are required to provide individualized, evidence-based, multidisciplinary support that includes:
- a physician-prescribed, supervised exercise regime
- an individualized treatment plan
- education and training on symptom management, medications, and use of oxygen
- a psychosocial assessment
- an outcomes assessment
Some pulmonary rehab programs may also include:
- personalized nutritional guidance
- help with stress management
- a smoking cessation program
- peer support and interaction with other COPD patients
Rehab can give you the opportunity to meet and connect with other people who are dealing with COPD. This type of support system can be invaluable.
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