Original Medicare provides a comprehensive pulmonary rehabilitation program for a person who has chronic issues with breathing.

Original Medicare includes Part A, which is hospital insurance, and Part B, which is medical insurance. As healthcare professionals generally offer a rehabilitation program (PR) in an outpatient setting, this coverage falls under Part B.

Medicare Advantage (Part C) plans, an alternative to Original Medicare, also cover the program. Another option is Medicare supplement insurance (Medigap), which may also help with some costs.

This article discusses Medicare coverage and out-of-pocket costs for pulmonary rehabilitation, as well as eligibility requirements for coverage. It then describes the program and explains how a person can find assistance in their area.

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Both Original Medicare and Medicare Advantage cover up to two 1-hour sessions per day for a total of 36 sessions during up to 36 weeks of PR for a person who has moderate to very severe chronic obstructive pulmonary disease (COPD).

Original Medicare

In Original Medicare, Part B covers pulmonary rehabilitation.

If a person gets the service in a doctor’s office, they pay 20% of the Medicare-approved cost. When someone receives the service in a hospital outpatient setting, they must also pay the hospital a copay for each session.

In either of these cases, a person must also pay the Part B annual deductible, which is $240 in 2024. This is in addition to the monthly premium of at least $174.70, based on annual income.

Sometimes a healthcare professional may recommend more sessions than Medicare allows. If this happens, a person may have to pay all or part of the cost. This online tool can help an individual check costs.

Medigap

Medigap, which is Medicare supplement insurance, may cover part or all of the coinsurance, deductible, and copay costs associated with PR. A person can check the 10 different plans to find the one that is most suitable for their needs.

Medicare Part D

A person with original Medicare is eligible to buy a Part D plan to get prescription drug coverage. However, Part D does not provide coverage for PR.

Medicare Advantage

Medicare Advantage (Part C) is an alternative to Original Medicare and provides all the benefits of Part A and Part B, which include PR coverage.

However, the out-of-pocket costs differ. Costs associated with Medicare Advantage plans include monthly premiums, coinsurance, copays, and deductibles. These expenses vary among plans.

Medicare Advantage plans also typically require a person to see in-network healthcare professionals.

Medicare’s requirements for coverage of PR programs are as follows:

  • A person must have moderate to very severe breathing conditions, such as COPD or COVID-19.
  • A doctor must decide that the rehabilitation is medically necessary and provide a referral to the program.
  • The program must comply with Medicare’s documentation requirements.

PR is a program for people with lung conditions that make it difficult to breathe, including COPD.

A healthcare professional may also recommend PR for people with other diseases and conditions that affect their breathing, such as:

  • muscle atrophy disorders, such as muscular dystrophy, that affect the muscles a person uses to breathe
  • cystic fibrosis, which causes a blockage in a person’s airways through a sticky mucus
  • a lung condition that causes lung scarring, such as pulmonary fibrosis

A doctor might also recommend a person for PR before and after lung surgery.

COPD is a condition that results from damage to the airways or other parts of the lungs. This causes airflow blockage and makes it difficult to breathe.

Symptoms of COPD include:

  • a persistent cough that typically produces mucus
  • shortness of breath, especially during physical activity
  • wheezing or whistling when breathing
  • fatigue
  • chest tightness or heaviness

COPD ranges from mild to severe. Treatment generally includes lifestyle changes, such as quitting smoking, and medications. It also includes PR to help a person to breathe better.

Learn about COPD.

Healthcare professionals work together to design a PR program tailored to the needs of each person. The program includes health education and exercises.

Although results vary, a person can expect some or all of the following benefits from rehabilitation programs:

  • increased understanding and management of the condition
  • improved strength, enabling a more active lifestyle
  • reduced symptoms of depression and anxiety
  • opportunities for peer support

Before the PR program starts, the healthcare team may ask a person to do one or more of the following tests:

  • 6-minute walk test to gauge the capacity for exercise
  • pulmonary function test to evaluate breathing
  • exercise stress test to measure heart rate, blood pressure, and oxygen level during physical activity

When the program starts, it will include exercise training to build stamina and flexibility. It may also include some of the following:

  • breathing techniques, such as yoga, to help ease the sense of being out of breath
  • instruction in finding easier, energy-saving ways to do everyday tasks
  • help to quit smoking
  • psychological counseling for mental health issues
  • nutritional counseling for optimal health

At the end of the rehabilitation, the healthcare team may retest a person to see how much their breathing has improved.

If someone believes they might benefit from a PR program, they may wish to discuss it with their doctor.

To get more information about a program, a person can contact the American Lung Association Helpline at 800-LUNGUSA (800-586-4872). They can also speak with their healthcare professional for more information on PR programs.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

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People with Original Medicare may get coverage for pulmonary rehabilitation through Part B. They will need to pay coinsurance, the annual deductible, and possibly a copay.

Individuals with Medicare Advantage (Part C) also have coverage for this type of treatment. However, the out-of-pocket costs differ from those of Original Medicare.

Medicare typically covers up to two 1-hour sessions per day, up to 36 sessions in up to 36 weeks.