Mario Oikonomides credits a massive heart attack when he was 38 with sparking his love of exercise, which he says helped keep him out of the hospital for decades after.
While recovering, he did something that only a small percentage of patients do: He signed up for a medically supervised cardiac rehabilitation program, where he learned about exercise, diet and prescription drugs.
“I had never exercised before,” said Oikonomides, 69, who says he enjoyed it so much he stayed active after finishing the program.
Despite evidence showing that such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify them for rehab actually participate. Various studies show that women and minorities, especially African Americans, have the lowest participation rates.
“Frankly, I’m a little discouraged by the lack of attention,” said Brian Contos, who has studied the programs for the Advisory Board, a consulting firm used by hospitals and other medical providers.
Now, though, advocates say cardiac rehab may be gaining traction, partly because the federal health-care law puts hospitals on the financial hook if patients are readmitted after cardiac problems. Studies have shown that patients’ participation in cardiac rehab cut hospital readmissions by nearly a third and saved money.
Oikonomides, who lives in Charlottesville, Va., went for three decades without a second heart attack, but he recently had bypass surgery because of blockages in his heart.
He is again rebuilding his strength at the University of Virginia Health System. “I attribute my 30 good years of life to cardiac rehab,” he said recently while pedaling on a stationary bike in a light-filled gym at an outpatient medical center, a heart monitor strapped to his chest.
But many patients still face hurdles.
Uninsured people simply can’t afford cardiac rehab. And for those with coverage, “the No. 1 barrier is the cost of the co-pay, which is frustrating,” said Ellen Keeley, a cardiologist at U-Va., who strongly encourages her patients to enroll.
Medicare and most private insurers generally cover cardiac rehab for people who have had heart attacks, coronary bypass surgery, heart failure and several other conditions. Most coverage is two or three hour-long visits per week, up to 36 sessions.
Insured patients usually must make a per-visit co-payment. For traditional Medicare members, that runs about $20 a session, although many have supplemental insurance that covers that cost. For patients with job-based insurance — and for enrollees in Medicare Advantage – out-of-pocket costs can range from nothing to more than $60 a pop.
UnitedHealthcare, with nearly 3 million members in Medicare Advantage plans, said patient payments for cardiac rehab vary widely. About 12 percent of members pay nothing, while 23 percent pay $50 a session. Another large insurer, Humana, has a similar range.
Nationally, the weighted average payment for Medicare Advantage members is just a bit more than the $20 that patients in traditional Medicare pay, said Dale Summers, director of the Center for Medicare & Medicaid Services’ division of finance and benefits.

Despite evidence showing that such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify them for rehab actually participate. Various studies show that women and minorities, especially African Americans, have the lowest participation rates.