Following a serious illness or injury, you may require inpatient rehabilitation. Medicare’s inpatient coverage breaks down into benefit periods, of which there can be several in a calendar year.
It’s stressful to have a health emergency. Besides not feeling well, you may also be concerned about Medicare coverage. Even if you have not been a Medicare participant for long, you know that you will have some out-of-pocket costs for inpatient hospital stays and follow-up rehab.
Here’s what you need to know about Medicare coverage for stays in an inpatient rehabilitation facility (sometimes called IRF, acute care rehabilitation center, or rehabilitation hospital).
What is an inpatient rehabilitation facility?
Before we continue our discussion of Medicare coverage of rehab, you must understand the basic difference between an inpatient rehabilitation facility and a skilled nursing facility (SNF).
Inpatient rehabilitation facilities are generally for patients recovering from a serious surgery, illness, or injury who need an intensive rehabilitation therapy program that a physician supervises. Medicare-covered inpatient rehabilitation care can include physical therapy, occupational therapy, and speech-language pathology.
What’s the difference between a rehab facility and a skilled nursing facility?
A skilled nursing facility is required if you need skilled nursing or therapy to treat and manage your condition and evaluate your care. Physical therapy, occupational therapy, and speech-language pathology are available if needed to meet your health goal.
Even though there is some overlap in the type of care received, inpatient rehab facilities provide short-term, inpatient rehabilitative care. Skilled nursing facilities are for those who require a higher level of medical care.
Medicare coverage of inpatient rehab facilities
Medicare Part A (Hospital Insurance) covers medically necessary intensive rehabilitation. Your healthcare provider must certify that you have a medical condition requiring intensive rehabilitation, continued medical supervision, and the need for coordinated care from your doctors and therapists.
Your Medicare-covered inpatient rehabilitation care includes your rehabilitation services, including physical therapy, occupational therapy, speech-language pathology, and other hospital services and supplies. It also includes the following:
- A semi-private room
- Prescription drugs
- Skilled nursing care
Even though Medicare covers stays in rehab facilities, you will have to pay for a portion of your treatment.
Your out-of-pocket costs in Original Medicare
We know you have questions about how much will Medicare pay for your stay in a rehab facility. However, the answer is fairly complicated. To understand Medicare benefits, you need to learn about the concept of a benefit period.
What is a benefit period?
A benefit period begins the day you’re admitted as a hospital inpatient. The benefit period ends when you haven’t received inpatient hospital care for 60 consecutive days.
So, if you were transferred to an IRF directly from an acute care hospital, you would only be charged one deductible – because you would have already paid one deductible for your benefit period. The same is true if you were admitted to a rehabilitation facility within 60 days of being discharged from a hospital.
Medicare Parts A & B
While Medicare Part A covers most of your inpatient rehabilitation services, Medicare Part B (Medical Insurance) covers doctors’ services you receive while you’re in an inpatient rehabilitation facility. The Medicare Part B deductible is currently $240.
If you are directly admitted to an inpatient rehab facility, here’s how your out-of-pocket charges work:
- Days 1-60: $1,632 deductible (if you have not already paid this during your benefit period).
- Days 61-90: A $408 copayment per day
- Days 91 and beyond: An $816 copayment per lifetime reserve day
- Each day after the lifetime reserve days: All costs
You receive up to a maximum of 60 reserve days over your lifetime.
What Medicare doesn’t cover
Medicare doesn’t cover private-duty nursing – or a private room. The program also doesn’t cover personal care items like toothbrushes, razors, or socks. You may also have to pay out-of-pocket for a television or phone in your room.
How to lower your out-of-pocket costs for Medicare rehab
You can save on outpatient and inpatient out-of-pocket healthcare costs by signing up for a Medicare Part C (Medicare Advantage) or Medigap plan during open enrollment.
Medicare Advantage plans are offered by private health insurance companies, and they cover everything that Original Medicare covers. However, they may also provide extended coverage and may pay more for rehab care than Original Medicare.
Medigap plans help cover your out-of-pocket costs when you have Original Medicare. In addition to covering your Part A deductible, some plans also pay your daily coinsurance – and provide an additional 365 lifetime reserve days for inpatient care.
If you aren’t sure which choice is better for you, the licensed agents at ClearMatch Medicare will answer your questions and help you understand your options. Or, do a bit more research into the Medicare plans in your area with our Find a Plan tool. Just enter your location information to get started.