Sometimes, an illness or major surgery can lead you to recovery that can’t start at home. That might require inpatient rehabilitation (or rehab) care to return you to full health.
But you might wonder if Medicare will absorb the costs of inpatient rehab care. Read more to find our full breakdown of this topic and how it works to decide how to proceed.
Is inpatient rehab included in Medicare?
Medicare coverage for inpatient rehab care is covered under Medicare Part A. You may receive skilled rehabilitation therapy to help you recover from severe injuries, surgery, or sickness.
Inpatient rehabilitation services may be received in a skilled nursing facility, an inpatient rehabilitation center, an acute care rehabilitation center, or a rehabilitation hospital.
Medicare covers inpatient rehabilitation if your doctor verifies that you have a medical condition that requires intensive rehabilitation, continuing medical supervision, and collaboration between doctors and therapists.
Medicare will cover your rehabilitation services, such as physical therapy, occupational therapy, and speech-language pathology. In addition, Medicare will pay for a semi-private room, meals, nursing assistance, medicines, and other hospital goods provided throughout your stay. Medicare won’t pay for private-duty nursing.
What is considered inpatient rehab?
After a hospital stay, many people get inpatient rehabilitation treatment, a type of inpatient care. Suppose your ailment or condition requires close coordination between your doctor and caregivers. In that case, you may receive specialized nursing care to recuperate after your initial therapy.
Many Medicare beneficiaries utilize inpatient rehab for a variety of reasons. A skilled nursing home staff can keep track of your condition and provide care at all times. Facility caregivers may provide personal care services and other daily living activities.
On-site medical professionals may assist with your therapy. Many people receive physical and occupational therapy during their stay.
How long does Medicare pay for a hospital stay?
Medicare will cover 100 days of care, including physical therapy, occupational therapy, and speech-language pathology services, and pays for a semi-private room, meals, nursing assistance, medicines, and other hospital goods and services.
Medicare covers the first 20 days at 100%. Starting the 21st day, you will have a set per day copay until day 100. Once you reach day 101, your coverage will expire.
You would need another hospitalization and a re-order of the inpatient rehab to restart the benefit period.
What’s included in Medicare rehab coverage?
Medicare covers inpatient rehabilitation in a skilled nursing facility. The 3-day rule for Medicare implies that you must be admitted to the hospital as an inpatient for at least three days for rehabilitation in a skilled nursing home to be covered.
Suppose a hospital admits you for observation only. In that case, Medicare won’t cover your stay in a skilled nursing facility following discharge from the hospital.
Medicare coverage for rehab in an inpatient rehab facility
Medicare covers inpatient rehab at inpatient rehabilitation facilities when considered medically necessary.
Your doctor must indicate your medical condition requires intensive rehabilitation, continued medical supervision, and coordinated care from your doctors and therapists working together.
Medicare-covered inpatient rehab after surgery
If you have surgery, Medicare covers your inpatient rehabilitation care. But there are some exceptions. Medicare won’t cover your stay if it’s mainly for recovery or rehabilitation and you don’t require skilled nursing care.
Medicare also doesn’t cover stays mainly for substance abuse treatment unless it’s part of a hospital stay for another condition.
For Medicare to cover your inpatient rehabilitation care, you must have a hospital discharge you after an illness or injury. You need skilled nursing care to help you recover. Your doctor orders Medicare-covered rehabilitation services, such as physical therapy, occupational therapy, or speech-language pathology and services.
Medicare Supplement coverage for inpatient rehab
If you’re on a Medicare Supplement policy, it may help pay for some of your inpatient rehabilitation costs. Medicare Supplement policies vary, so you must check with your insurance company to determine what your plan letter covers. Typically if Medicare covers any portion, your Medigap plan will pick up some or all of your part of the costs.
Medicare Advantage coverage for inpatient rehab
Enrolling in a Medicare Advantage Plan may help pay for some of your inpatient rehabs. Medicare Advantage policies vary but must provide coverage at the same level as Original Medicare.
Check with your plan provider or a licensed insurance broker to see the Medicare Advantage benefits on your current plan and plans in your area.
Does Medicare cover rehab after a hospital stay?
Medicare will cover rehab after a hospital stay. Depending on what kind of rehab is needed, it could be performed in an outpatient setting or in a skilled nursing facility.
Does Medicare cover rehab after surgery?
If your surgery requires rehab, Medicare will cover the rehabilitative services.
How do I know if Medicare will cover my inpatient rehab stay?
You’ll need to contact Medicare to find out if Medicare will cover your inpatient rehab stay. You can also visit Medicare’s website at www.medicare.gov.
How long will Medicare cover my inpatient rehab?
Medicare covers 100 days of care, including physical therapy, occupational therapy, and speech-language pathology services. Medicare also pays for a semi-private room, meals, nursing assistance, medicines, and other hospital goods.
Can my spouse or children come to the rehab facility with me?
Medicare doesn’t cover the costs for your spouse or children to stay with you in the rehab facility. You’ll need to make arrangements for them to stay somewhere else.
What if I don’t have a Medicare Supplement policy?
If you don’t have a Medicare Supplement policy or Medicare Advantage plan, you will pay your Original Medicare cost-share.
Can I continue my rehab after Medicare’s 100 days?
Medicare doesn’t cover any costs for continued rehab care once you’ve reached the 100-day limit. You must arrange ongoing care with your doctor or another rehab facility.
Getting help protecting yourself from the costs of inpatient rehab
Many Medicare beneficiaries constantly learn what they need to protect themselves from potentially high out-of-pocket costs, so you’re not alone in wondering.
You might consider a Medigap plan if you want additional benefits to supplement your Medicare coverage.
Our licensed insurance agents can educate you on your options and help you solve your unique needs.
To speak with licensed insurance brokers specializing in Medicare, call us today. Or fill out our online request form to receive the best rates in your area.
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