Medicare covers most services when deemed medically necessary by a qualified healthcare provider.
Medicare Part A covers a variety of rehab services at an inpatient rehabilitation facility after a qualifying hospital stay. Part A beneficiaries are also covered for rehabilitation services received in a skilled nursing facility (SNF).
Please note that, just as with other types of health insurance, Medicare only covers short-term care, i.e. fewer than 100 days. Long-term care is not covered by Medicare – or any other type of health insurance.
What does Medicare Part A cover?
Original Medicare includes two parts:
- Medicare Part A is also known as hospital insurance. It covers inpatient care received in a hospital, skilled nursing facility, mental health facility, and rehabilitation hospital. Part A also helps pay for hospice care.
- Medicare Part B is sometimes called medical insurance. It covers medically necessary outpatient services such as doctor visits, lab work, mental health care, and durable medical equipment (DME). Medicare coverage also includes some preventive services, like flu shots and mammograms. Part B also covers limited medications that are administered by a healthcare provider, mainly injectable and infused drugs. This does not include self-administered medications, such as those you would fill at a pharmacy.
Prescription drug coverage is not included with Original Medicare. Those benefits are provided by Medicare Part D. You can get prescription drug coverage by joining either a standalone Part D prescription drug plan (PDP) or a Medicare Advantage Prescription Drug plan (MA-PD).
How does Medicare Part A cover rehabilitation services?
Medicare Part A covers rehabilitation services that have been deemed medically necessary by your healthcare provider. This assumes you first had a qualifying three-day hospital stay. In addition, your doctor must:
- Confirm that you require rehabilitative care to treat your medical condition
- Certify that your condition requires continued medical supervision
- Coordinate your care with your rehabilitative team (providers typically include your primary doctor as well as specialists, nurses, and rehabilitation therapists)
As always, Medicare rehab coverage assumes your healthcare providers accept assignment. In addition to your medical team, the rehabilitative facility you use must also accept Medicare.
What rehab services does Medicare cover?
You may require inpatient rehabilitation following an illness, acute injury, or surgery. Assuming you meet the qualifications, Medicare will cover the following:
- Physical therapy
- Occupational therapy
- Speech-language pathology
- A semi-private room
- Drugs as administered by your medical provider, including nurse practitioners and registered nurses
- Skilled nursing care
Medicare will not cover a private room that has not been prescribed as medically necessary by your healthcare provider. Part A also won't pay for a private nurse, personal items like toothpaste that aren't included with admission, and a phone or TV in your room.
Where can you receive inpatient rehabilitative care if you have Medicare?
Part A helps pay for inpatient rehabilitation services received in any of the following:
- Inpatient rehabilitation facility (IRF)
- Acute care rehabilitation center
- Rehabilitation hospital
- Skilled nursing facility
Again, Medicare only covers short-term rehabilitative care.
How much does inpatient rehab cost with Medicare?
Medicare Part A costs per benefit period include the $1,632 deductible as well as coinsurance, which is:
- $0 for the first 60 days
- $408 per day for days 61 through 90
- $816 per day for days 91 through your 60 lifetime reserve days
A benefit period starts the day you are admitted to the hospital as an inpatient. It ends once you go 60 consecutive days without receiving inpatient care. If you enter a rehab facility within 60 days of being discharged from the hospital, then you are still within that benefit period. This means you do NOT have a separate deductible for your rehabilitation.
If you receive your Medicare rehab services in a skilled nursing facility, coinsurance is figured differently.
- Medicare pays all costs for days 1 through 20
- For days 21 through 100, your copayment or coinsurance is $204 per day
Once you hit 100 days, Medicare no longer covers skilled nursing care.
IMPORTANT: Time you spend in the hospital as an outpatient does not count toward the three-day requirement. That means that time you spend under observation status or as a hospital outpatient is not included. This is a vital distinction as Medicare only covers inpatient rehab after a qualifying inpatient hospital stay.
Who qualifies for Medicare rehab coverage?
Eligibility for Medicare rehab coverage starts with having Medicare Part A. You qualify for Medicare if you are a U.S. citizen or permanent legal resident and at least one of the following applies to you:
- Are age 65 or older
- Receive disability benefits through either Social Security or the Railroad Retirement Board (RRB) for 24 months
- Have either amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) or end-stage renal disease (ESRD)
If you qualify for Medicare Part A but have not yet enrolled, you may do so through the Social Security Administration by clicking here. Although the Centers for Medicare and Medicaid Services (CMS) oversee the Medicare program, registration is through Social Security.
Does Medicare Advantage cover rehab?
Medicare Part C, more commonly known as Medicare Advantage, must provide the same benefits you get with Original Medicare (Parts A and B). However, most Medicare Advantage plans also provide extra benefits. For particulars about your Advantage plan's coverage and costs for short-term rehab care, please refer to your plan provider.
Does Medigap cover short-term rehabilitation?
Medicare Supplement Insurance, more commonly known as Medigap, helps pay a variety of out-of-pocket costs when you have Original Medicare. (You cannot pair a Medigap plan with a Medicare Advantage plan).
There are 10 standardized Medicare Supplement plans, each represented by a letter: A, B, C, D, F, G, K, L, M, and N. Benefits vary according to the plan you choose. However, at a minimum, every Supplement plan covers the Medicare Part A deductible and gives you an additional 365 lifetime reserve days as a hospital inpatient.
Compare your Medicare plan options with our Find a Plan tool. Just enter your location information to compare Medicare Advantage, Part D, and Medigap plans in your area.