Medicare coverage for inpatient rehabilitation

Medicare Part A covers medically necessary inpatient rehab (rehabilitation) care, which can help when you’re recovering from serious injuries, surgery or an illness. Inpatient rehab care may be provided in of the following facilities:

• A skilled nursing facility
• An inpatient rehabilitation facility (inpatient “rehab” facility or IRF)
• Acute care rehabilitation center
• Rehabilitation hospital

For inpatient rehab care to be covered, your doctor needs to affirm the following are true for your medical condition:

1. It requires intensive rehab
2. It needs continued medical supervision
3. It needs coordinated care from your doctors and therapists working together

Medicare will cover your rehab services (physical therapy, occupational therapy and speech-language pathology), a semi-private room, your meals, nursing services, medications and other hospital services and supplies received during your stay. Medicare won’t cover private duty nursing, a phone or TV, personal items or a private room (unless deemed medically necessary).

The specifics about what Medicare pays and for how long depend on the type of care needed and where it’s provided. Costs and coverage for inpatient rehab in a skilled nursing facility follow coverage rules for skilled nursing facility care.

Medicare covers inpatient rehab in a skilled nursing facility – also known as an SNF – for up to 100 days. Rehab in an SNF may be needed after an injury or procedure, like a hip or knee replacement.

The costs for a rehab stay in a skilled nursing facility are as follows:

• You usually pay nothing for days 1–20 in one benefit period, after the Part A deductible is met.
• You pay a per-day charge set by Medicare for days 21–100 in a benefit period.
• You pay 100 percent of the cost for day 101 and beyond in a benefit period.

Medicare covers inpatient rehab in a skilled nursing facility after a qualifying hospital stay that meets the 3-day rule. The 3-day rule for Medicare requires that you are admitted to the hospital as an inpatient for at least 3 days for rehab in a skilled nursing facility to be covered. You must be officially admitted to the hospital by a doctor’s order to even be considered an inpatient, so watch out for this rule. In cases where the 3-day rule is not met, Medicare may cover outpatient rehab.

Medicare covers inpatient rehab in an inpatient rehabilitation facility – also known as an IRF – when it’s considered “medically necessary.” You may need rehab in an IRF after a serious medical event, like a stroke or a spinal cord injury.

To qualify for care in an inpatient rehabilitation facility, your doctor must state that your medical condition requires the following:

• Intensive rehabilitation
• Continued medical supervision
• Coordinated care from your doctors and therapists working together

The costs for rehab in an inpatient rehabilitation facility are as follows:

• You usually pay nothing for days 1–60 in one benefit period, after the Part A deductible is met.
• You pay a per-day charge set by Medicare for days 61–90 in a benefit period.
• You may use up to 60 lifetime reserve days at a per-day charge set by Medicare for days 91–150 in a benefit period.
• You pay 100 percent of the cost for day 150 and beyond in a benefit period.

Your inpatient rehab coverage and costs may be different with a Medicare Advantage plan, and some costs may be covered if you have a Medicare supplement plan. Check with your plan provider for details.

Your costs may also be different if you were transferred to an inpatient rehab facility either directly from an acute care hospital or within 60 days of being discharged from a hospital. In these situations, you won’t have to pay a deductible for the care you get at the inpatient rehab facility if you already paid a deductible for the prior hospitalization in the same benefit period.