Does Medicare Cover Pulmonary Rehabilitation?

Yes, Medicare Part B covers a comprehensive pulmonary rehabilitation program if you have moderate to very severe chronic obstructive pulmonary disease (COPD) and have a referral from the doctor treating this chronic respiratory disease. The bottom line: if your doctor says you need it and you meet the criteria, Medicare helps pay for it.

Pulmonary rehabilitation is a program that helps you breathe better and improves your quality of life. It includes exercise, education, and counseling. When you're dealing with a serious lung condition, the last thing you need is confusion about what your insurance covers. We're here to give you straight answers, no surprises.

What Exactly Does Medicare Cover?

Under Original Medicare (Part A and Part B), pulmonary rehabilitation is covered under Part B (Medical Insurance). This coverage includes:

• Exercise training
• Education about your disease and how to manage it
• Nutrition counseling
• Psychological counseling

Medicare will cover up to two one-hour sessions per day, for up to 36 lifetime sessions (in some cases, up to 72 sessions if medically necessary).

What Will It Cost You?

If you have Original Medicare, you pay 20% of the Medicare-approved amount for the services you get in your doctor's office or in a hospital outpatient setting. The Part B deductible applies. If you get these services in a hospital outpatient setting, you also pay a copayment per session.

This is where the rubber meets the road. Insurance is a cost, not an investment. You've paid into the system your whole life, and now it's time to protect what you've earned. But the system isn't designed to be easy to navigate.

The Two Paths: Traditional Medicare vs. Medicare Advantage

When it comes to Medicare, you have two main paths. The real choice is Traditional Medicare (A+B) vs Medicare Advantage.

If you choose Traditional Medicare, you can add a Medicare Supplement (Medigap) plan. A Medigap plan fills the gaps by law. If Medicare Part B covers 80% of your pulmonary rehabilitation, a Medigap plan (like Plan G) will step in and pay the remaining 20% coinsurance, leaving you with zero out-of-pocket costs for the sessions once your Part B deductible is met. The supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, not an alternative to Advantage.

If you choose a Medicare Advantage plan (Part C), your plan must cover at least the same pulmonary rehabilitation services as Original Medicare. However, your costs, copayments, and network restrictions will depend on your specific plan. You may need prior authorization or be required to use in-network facilities.

How to Qualify

To get Medicare coverage for pulmonary rehabilitation, you must:

• Have moderate to very severe COPD.
• Get a referral from the doctor treating your COPD.
• Receive the services in a doctor's office or a hospital outpatient setting that offers pulmonary rehabilitation programs.

You don't have to figure this out alone. We're on your side of the table. We'll walk you through every option and help you understand exactly how your coverage works for the treatments you need. Compare free, no obligation.