How long will medicare pay for rehab facility

When will Medicare cover your stay in a rehab hospital?
A question you may have, when you need this kind of care, is whether Medicare will cover your stay? It all depends. Certain conditions, such as a stroke, spinal cord, or brain injury, may qualify you to get coverage for care in a rehab hospital. Unfortunately, two common procedures—hip and knee replacement surgeries—may not qualify you for rehab care unless you have a condition that complicates the surgery’s outcome. 

This may seem confusing, but when you’re seeking Medicare coverage, there are certain criteria your situation must meet. For example, you must require 24-hour access to a registered nurse with specialized training or experience in rehabilitation. And, in order to you to qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary. 

When you do qualify, It’s a good idea to be aware of what services are included in Medicare’s rehab coverage. On that all-important list, you’ll find medical care and rehabilitation nursing; physical, occupational, and speech therapy; social worker assistance; psychological services and orthotic and prosthetic services; a semi-private room, meals, and drugs. Don’t, however, expect Medicare rehab coverage to pick up the tab for personal items like toothpaste, the television, or a phone in your room.

As with other inpatient hospital stays, Medicare won’t pay for everything. One common mistake people make with Medicare is not being aware of their out-of-pocket costs. If you are in a rehab hospital, your out-of-pocket costs will be the same as costs for any other inpatient hospital stay.  

Understand too, that if you enter a rehabilitation hospital after being an inpatient at a different facility, you’ll still be in the same benefit period. And if you don’t qualify for a Medicare-covered stay in an inpatient rehab hospital, you may qualify for rehabilitation care from a skilled nursing facility, a home health agency, or an outpatient setting.

What does Medicare cover for cardiac rehabilitation?
A cardiac incident like a heart attack can be debilitating and require extensive recovery time and rehab. Fortunately, there is coverage for cardiac rehab, though it won’t necessarily have to happen at a rehab hospital.

If you need comprehensive cardiac rehabilitation (CCR), Medicare Part B covers that, including exercise, education, and counseling. Part B also covers the more rigorous cardiac rehabilitation (ICR), again including exercise, education, and counseling. ICR programs may be offered in a doctor’s office or as an outpatient service at a hospital. If you receive services in a doctor’s office, you’ll have to pay 20 percent of the Medicare-approved amount for them. If you use the services of a hospital, expect to pay a copayment to the hospital. The Part B deductible applies. 

What qualifies you for Part B coverage of ICR? You must have had at least one of these conditions:

• A heart attack within the last 12 months
• Coronary artery bypass surgery
• Current stable angina pectoris
• A heart-valve repair or replacement
• A coronary angioplasty or coronary stent
• A heart or heart-lung transplant
• Stable chronic heart failure

Rest assured that an ICR program is covered if your doctor orders it and you have one or more of the conditions listed above (excluding stable chronic heart failure—for that, CCR is covered). 

What’s your doctor’s role in getting you rehab care?
Essentially, for you to get Medicare coverage, your doctor must state that your condition is serious enough that—to keep you safe and to provide the best possible treatment—you need the following: 

• Twenty-four-hour-a-day access to a doctor (meaning you require frequent, direct doctor involvement, at least every two to three days
• Twenty-four-hour-a-day access to a registered nurse with specialized training or experience in rehabilitation
• Intensive therapy, which typically means at least three hours of therapy per day. (Note that exceptions can be made on a case-by-case basis. You may still qualify if you’re not healthy enough to withstand three hours of therapy per day.)
• A coordinated team of providers including but not limited to, a doctor, rehab nurse, and a therapist.

Your doctor’s expectations are part of the criteria, too. Your doctor must expect that your condition will improve enough for you to regain your independence after a rehabilitation hospital stay. That means you should be able to resume activities of daily living on your own, like being able to eat, bathe, and dress yourself, living at home either alone, or with family or a companion. 

How long will Medicare pay for a rehab facility?
Medicare Part A covers all or part of 100 days in a skilled nursing facility with some coinsurance costs. After day 100 of an inpatient SNF stay, you are responsible for all costs.

Medicare Part A will also cover 90 days of inpatient hospital rehab with some coinsurance costs after you meet your Part A deductible. Beginning on day 91, you will begin to tap into your “lifetime reserve days.”

Keep in mind that some Medicare Advantage plans may offer additional rehab time coverage.

Are you interested in learning more about what Medicare does and doesn’t cover? Sign up for YourMedicare.com’s free monthly newsletter.

 Approved YM04012109

Return to: Medicare In-Depth

When will Medicare cover your stay in a rehab hospital?
A question you may have, when you need this kind of care, is whether Medicare will cover your stay? It all depends. Certain conditions, such as a stroke, spinal cord, or brain injury, may qualify you to get coverage for care in a rehab hospital. Unfortunately, two common procedures—hip and knee replacement surgeries—may not qualify you for rehab care unless you have a condition that complicates the surgery’s outcome. 

This may seem confusing, but when you’re seeking Medicare coverage, there are certain criteria your situation must meet. For example, you must require 24-hour access to a registered nurse with specialized training or experience in rehabilitation. And, in order to you to qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary. 

When you do qualify, It’s a good idea to be aware of what services are included in Medicare’s rehab coverage. On that all-important list, you’ll find medical care and rehabilitation nursing; physical, occupational, and speech therapy; social worker assistance; psychological services and orthotic and prosthetic services; a semi-private room, meals, and drugs. Don’t, however, expect Medicare rehab coverage to pick up the tab for personal items like toothpaste, the television, or a phone in your room.

As with other inpatient hospital stays, Medicare won’t pay for everything. One common mistake people make with Medicare is not being aware of their out-of-pocket costs. If you are in a rehab hospital, your out-of-pocket costs will be the same as costs for any other inpatient hospital stay.  

Understand too, that if you enter a rehabilitation hospital after being an inpatient at a different facility, you’ll still be in the same benefit period. And if you don’t qualify for a Medicare-covered stay in an inpatient rehab hospital, you may qualify for rehabilitation care from a skilled nursing facility, a home health agency, or an outpatient setting.

What does Medicare cover for cardiac rehabilitation?
A cardiac incident like a heart attack can be debilitating and require extensive recovery time and rehab. Fortunately, there is coverage for cardiac rehab, though it won’t necessarily have to happen at a rehab hospital.

If you need comprehensive cardiac rehabilitation (CCR), Medicare Part B covers that, including exercise, education, and counseling. Part B also covers the more rigorous cardiac rehabilitation (ICR), again including exercise, education, and counseling. ICR programs may be offered in a doctor’s office or as an outpatient service at a hospital. If you receive services in a doctor’s office, you’ll have to pay 20 percent of the Medicare-approved amount for them. If you use the services of a hospital, expect to pay a copayment to the hospital. The Part B deductible applies. 

What qualifies you for Part B coverage of ICR? You must have had at least one of these conditions:

• A heart attack within the last 12 months
• Coronary artery bypass surgery
• Current stable angina pectoris
• A heart-valve repair or replacement
• A coronary angioplasty or coronary stent
• A heart or heart-lung transplant
• Stable chronic heart failure

Rest assured that an ICR program is covered if your doctor orders it and you have one or more of the conditions listed above (excluding stable chronic heart failure—for that, CCR is covered). 

What’s your doctor’s role in getting you rehab care?
Essentially, for you to get Medicare coverage, your doctor must state that your condition is serious enough that—to keep you safe and to provide the best possible treatment—you need the following: 

• Twenty-four-hour-a-day access to a doctor (meaning you require frequent, direct doctor involvement, at least every two to three days
• Twenty-four-hour-a-day access to a registered nurse with specialized training or experience in rehabilitation
• Intensive therapy, which typically means at least three hours of therapy per day. (Note that exceptions can be made on a case-by-case basis. You may still qualify if you’re not healthy enough to withstand three hours of therapy per day.)
• A coordinated team of providers including but not limited to, a doctor, rehab nurse, and a therapist.

Your doctor’s expectations are part of the criteria, too. Your doctor must expect that your condition will improve enough for you to regain your independence after a rehabilitation hospital stay. That means you should be able to resume activities of daily living on your own, like being able to eat, bathe, and dress yourself, living at home either alone, or with family or a companion. 

How long will Medicare pay for a rehab facility?
Medicare Part A covers all or part of 100 days in a skilled nursing facility with some coinsurance costs. After day 100 of an inpatient SNF stay, you are responsible for all costs.

Medicare Part A will also cover 90 days of inpatient hospital rehab with some coinsurance costs after you meet your Part A deductible. Beginning on day 91, you will begin to tap into your “lifetime reserve days.”

Keep in mind that some Medicare Advantage plans may offer additional rehab time coverage.

Are you interested in learning more about what Medicare does and doesn’t cover? Sign up for YourMedicare.com’s free monthly newsletter.

 Approved YM04012109

Return to: Medicare In-Depth

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