Yes. Medicare Part B covers pulmonary rehabilitation, and for most people who qualify it covers up to 36 sessions. The part that catches people out is not whether Medicare pays. It is which conditions qualify, and what you are left paying.
Who qualifies
Medicare Part B covers pulmonary rehabilitation for two groups:
- Moderate to very severe COPD. This is the main pathway. Mild COPD does not qualify under this benefit.
- Confirmed or suspected COVID-19 with respiratory symptoms that have persisted for at least four weeks.
That second pathway is newer and a lot of people do not know it exists. If you had COVID and your breathing never came back to where it was, you may qualify for a full program even without a COPD diagnosis.
How many sessions you get
Medicare covers up to 36 sessions, spread over up to 36 weeks. You can do a maximum of two one hour sessions in a single day, though most people do not.
There is a second block of 36 sessions available in one specific circumstance: if you completed a program for one qualifying condition and later need rehabilitation for the other. Someone who finished a COPD program and then developed persistent post-COVID breathlessness, for example. It is not a general extension for people who simply want more sessions, which is how it often gets described.
What you pay
Part B does not pay everything. After your Part B deductible is met:
- In a doctor’s office setting, you pay 20% of the Medicare approved amount.
- In a hospital outpatient setting, you pay the hospital a copayment for each session.
Over 36 sessions that coinsurance adds up, so it is worth asking what your share works out to per session before you start. Many people with a Medigap or supplement plan find that portion is covered.
Why Medicare programs are usually group based
Medicare’s pulmonary rehabilitation benefit is built around a program model, and the reimbursement reflects that. Providers who deliver it one to one for every Medicare patient generally cannot sustain it, which is why hospital based programs run in cohorts.
Group is not a lesser version of the work. The exercise is still individually prescribed and a qualified clinician is still monitoring you. What changes is that you are doing it alongside other people, and for many patients that is the part that keeps them showing up.
Where Bloom Medical fits
To be straight with you: Bloom currently bills commercial insurance plans. We work with Aetna, Anthem BCBS, Cigna, Horizon BCBS and UnitedHealthcare, and those patients are seen one to one by video with a licensed respiratory therapist.
Medicare availability varies by state and changes as enrolment completes. If Medicare is your primary coverage, call and ask where things stand rather than assuming either way. If we cannot take you yet, we will tell you plainly and keep your details on file.
If you carry a commercial plan, whether or not you are over 65, that is the pathway we are built for.
What to ask before you enrol anywhere
Three questions will tell you most of what you need to know about any program:
- Do you bill Medicare directly for this, or is it a cash program? A surprising number of virtual providers do not bill Medicare at all and sell a subscription instead. That is a legitimate business model, but it is not your Part B benefit and it does not use your 36 sessions.
- Who is in the room with me? Pulmonary rehabilitation is respiratory care. Ask whether the person supervising is a licensed respiratory therapist or a general fitness coach following a script.
- What happens if I have a bad week? The value of supervision is that somebody adjusts. If nobody is looking at how you responded, you are doing a video course.
Frequently asked questions
Medicare covers the pulmonary rehabilitation benefit based on the service and the supervising clinician, not on the building you sit in. Virtual delivery has become widely available, but coverage depends on the individual provider’s billing arrangement, so ask the provider directly whether they bill Part B for virtual sessions.
Pulmonary rehabilitation requires a physician referral and physician oversight of your treatment plan. Your pulmonologist or primary care doctor can make it. If you are unsure whether you meet the severity threshold, that conversation is the right place to start.
Not under this specific Part B benefit. The qualifying conditions are moderate to very severe COPD and persistent post-COVID respiratory symptoms. People with moderate to severe asthma are frequently covered through commercial insurance instead, which is a separate pathway with different rules.
Sessions run at least 31 minutes for a single billed session. Two sessions on the same day require at least 91 minutes of treatment in total.
A second block of 36 is available only if you now qualify under the other covered condition. Otherwise, talk to your provider about maintenance options, which are usually not billed under the pulmonary rehabilitation benefit.
Finding out where you stand
The fastest way to know what your plan covers is to ask someone to check it. It takes a couple of minutes and you do not need your chart in front of you.
Call (866) 972-8228, or check your eligibility online. It takes a few minutes and needs no account.
This article is general information about Medicare coverage and is not a determination about your individual benefits. Coverage decisions are made by Medicare and your provider based on your clinical documentation.
