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Medicare Part A (Hospital Insurance) covers medically necessary care you get in an inpatient rehabilitation facility or unit (sometimes called an inpatient “rehab” facility, IRF, acute care rehabilitation center, or rehabilitation hospital). Your doctor must certify that you have a medical condition requiring intensive rehabilitation ...
Apr 24, 2024 · Medicare covers inpatient rehabilitation services under Medicare Part A if certain conditions are met. This article discusses what Medicare covers during a rehab admission, what guidelines rehabs must follow, what qualifies a person for rehab, and how to rate quality care at a rehab facility.
- Overview
- Does Medicare cover inpatient rehabilitation?
- What costs should you expect to pay?
- What services will Medicare cover during rehab?
- What are the guidelines for Medicare coverage?
- What is inpatient rehabilitation care?
- The takeaway
•Original Medicare (Part A and Part B) will pay for inpatient rehabilitation if it’s medically necessary following an illness, injury, or surgery once you’ve met certain criteria.
•In some situations, Medicare requires a 3-day hospital stay before covering rehabilitation.
•Medicare Advantage plans also cover inpatient rehabilitation, but the coverage guidelines and costs vary by plan.
Recovery from some injuries, illnesses, and surgeries can require a period of closely supervised rehabilitation. Medicare covers your treatment in an inpatient rehabilitation facility as long as you meet certain guidelines.
Medicare Part A covers your inpatient care in a rehabilitation facility as long as your doctor deems it medically necessary. In addition, you must receive care in a facility that’s Medicare-approved.
Depending on where you receive your inpatient rehab therapy, you may need to have a qualifying 3-day hospital stay before your rehab admission. We’ll discuss that rule in more detail later.
If you’re enrolled in original Medicare (Medicare Part A and Part B) in 2020, you’ll pay the following costs during each benefit period:
•Days 1 through 60. You’ll be responsible for a $1,364 deductible. If you transfer to the rehab facility immediately after your hospital stay and meet your deductible there, you won’t have to pay a second deductible because you’ll still be in a single benefit period. The same is true if you’re admitted to a rehab facility within 60 days of your hospital stay.
•Days 61 through 90. During this period, you’ll owe a daily coinsurance amount of $341.
•Day 91 and onward. You’ll pay $682 coinsurance for each of your lifetime reserve days. You have 60 lifetime reserve days. After you’ve used them all, you’re responsible for all costs.
During inpatient rehabilitation, a team of healthcare professionals will work together to help you function on your own again. Your treatment plan will be tailored to your condition but may include:
•assistance with orthotic or prosthetic devices
•occupational therapy
•physical therapy
•psychological services
•social services
Make sure you’re enrolled in Medicare
You can first enroll during a 7-month window called the initial enrollment period. This period starts 3 months before you turn 65 years old and ends 3 months after your birth month. Another opportunity to enroll is during Medicare’s open enrollment period, which is from October 15 to December 7 each year. If you’re considering a Medicare Advantage (Part C) plan, your enrollment period runs from January 1 through March 31 each year. Depending on your situation, you may also qualify for a special enrollment period.
Confirm your initial hospital stay meets the 3-day rule
Medicare covers inpatient rehabilitation care in a skilled nursing facility only after a 3-day inpatient stay at a Medicare-approved hospital. It’s important that your doctor write an order admitting you to the hospital. If you’ve spent the night in the hospital for observation or testing, that won’t count toward the 3-day requirement. These 3 days must be consecutive, and any time you spent in the emergency room before your admission isn’t included in the total number of days. Your discharge day is also not included in the 3-day total. Tip It can be hard to know if you’ve been admitted as an inpatient or how long your stay has been. This might leave you unsure whether you qualify for the 3-day rule. This is a helpful guide for determining your inpatient status. You can use this guide when talking with your doctor to get the information you need.
If you’re having surgery, check Medicare’s 2020 “inpatient only” list
Some surgical procedures always require admission as an inpatient. The 3-day rule does not apply for these procedures, and Medicare will cover your inpatient rehabilitation after the surgery. These procedures can be found on Medicare’s inpatient only list. In 2018, Medicare removed total knee replacements from the inpatient only list. In 2020, Medicare also removed total hip replacements from the list. The 3-day rule now applies to both of those procedures. If you have a Medicare Advantage plan, talk with your insurance provider to find out if your surgery is considered an inpatient-only procedure. Each plan’s coverage rules differ, and knowing whether the 3-day rule applies could save you a lot of money. Tip If you have a Medicare Advantage (Part C) plan, your costs may be higher or lower based on whether your healthcare providers and rehab facility are in network or out of network. Check with your plan before being admitted to a facility to make sure that it’s in network. This will help ensure full coverage and maximum cost savings.
Inpatient rehabilitation is goal driven and intense. You and your rehab team will create a coordinated plan for your care. The primary aim will be to help you recover and regain as much functionality as possible.
Your team will include registered nurses who specialize in rehab care, along with one or more physicians and rehab therapists, depending on your health condition. You might also receive assistance from psychologists, psychiatrists, or social workers who can help with your mental and emotional well-being.
You may work with a physical therapist to:
•rebuild your strength and ability to move
•increase your range of motion
•decrease pain and swelling
Original Medicare and Medicare Advantage plans pay for inpatient rehabilitation if your doctor certifies that you need intensive, specialized care to help you recover from an illness, injury, or surgical procedure.
You might receive inpatient rehabilitative treatment in a dedicated rehab department inside a hospital, at a skilled nursing facility, or at a separate rehabilitation clinic or hospital.
You must meet certain important conditions in order for Medicare to cover your inpatient rehab. You’ll still have to pay for the cost of coinsurance and deductibles, even with Medicare coverage.
While you’re in rehab, your care will be provided by a team that’ll include nurses, doctors, and therapists. They can help you get back on your feet as quickly and as safely as possible.
Medicare Part A (Hospital Insurance) covers inpatient hospital care if you meet both of these conditions: You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury; The hospital accepts Medicare
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.
Aug 29, 2024 · Medicare will pay for medically necessary inpatient and outpatient rehabilitation services. However, to be eligible for rehabilitation coverage, a person must meet certain...
People also ask
Does Medicare pay for inpatient rehabilitation?
Does Medicare cover rehabilitation?
Does Medicare cover inpatient rehabilitation in a skilled nursing facility?
Does Medicare cover inpatient hospital care?
Does Medicare pay for inpatient therapy?
Who pays for inpatient rehab?
Sep 1, 2023 · Medicare Part A covers inpatient rehabilitation in Skilled Nursing Facilities (SNF) and Inpatient Rehabilitation Facilities (IRF). Medicare Part B covers outpatient services like physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP).
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Compare Rx and health options now at Medicare.gov during Open Enrollment. Ends December 7. Compare drug and health options to find the right plan for you during Open Enrollment.
reliancemedicarehelpline.com has been visited by 10K+ users in the past month
Reliance® 2025 Medical Benefit Plans. Find Answers & Speak to a Licensed Sales Agent. Let's Go Over Your Medicare Options Together. Licensed Sales Agents Are Here to Help!
You Could Slip, So Why Wait? Start Your Free Medicare Walk-In Bathtub Quote Today! Medicare Walk-In Bathtubs - Get the Safety You Need & The Comfort you Deserve!
