| Tue, Dec 03, 2019 @ 12:56 PM

Medicare Coverage for Inpatient Rehabilitation

Posted by Medicare Made Clear

Medicare covers inpatient rehabilitation in a skilled nursing facility and inpatient rehabilitation facility differently. Medicare covers inpatient rehab (rehabilitation), which may be provided in two types of facilities:

  • A skilled nursing facility
  • An inpatient rehabilitation facility

In general, Medicare Part A (hospital insurance) covers a semi-private room and meals during an inpatient rehab stay, as well as nursing, medications, therapy and other services and supplies. Medicare Part B covers doctors’ services provided during your stay.

The specifics about what Medicare pays and for how long depend on the type of care needed and where it’s provided.

How Long Will Medicare Cover Rehab in a Skilled Nursing Facility?

Medicare covers inpatient rehab in a skilled nursing facility – also known as an SNF – for up to 100 days. Rehab in an SNF may be needed after an injury or procedure, like a hip or knee replacement.

Skilled Nursing Facility Cost

The costs for a rehab stay in a skilled nursing facility are as follows:

  • You usually pay nothing for days 1–20 in one benefit period, after the Part A deductible is met.
  • You pay a per-day charge set by Medicare for days 21–100 in a benefit period.
  • You pay 100 percent of the cost for day 101 and beyond in a benefit period.

Medicare covers inpatient rehab in a skilled nursing facility after a qualifying hospital stay that meets the 3-day rule. In cases where the 3-day rule is not met, Medicare may cover outpatient rehab.

What Is the 3-Day Rule for Medicare?

The 3-day rule for Medicare requires that you are admitted to the hospital as an inpatient for at least 3 days in order for rehab in a skilled nursing facility to be covered.

You might logically think that you are an inpatient if you stay overnight in a hospital room, but that’s not always the case. You must be officially admitted to the hospital by a doctor’s order to be considered an inpatient. Being in the hospital for observation doesn’t count.

It’s a good idea to ask and get clear documentation of your inpatient status, since this could save you money if you need care in a skilled nursing facility when you leave the hospital.

How Long Will Medicare Cover Rehab in an Inpatient Rehabilitation Facility?

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.

To qualify for care in an inpatient rehabilitation facility, your doctor must state that your medical condition requires the following:

  • Intensive rehabilitation
  • Continued medical supervision
  • Coordinated care from your doctors and therapists working together

Inpatient Rehabilitation Facility Cost

The costs for rehab in an inpatient rehabilitation facility are as follows:

  • You usually pay nothing for days 1–60 in one benefit period, after the Part A deductible is met.
  • You pay a per-day charge set by Medicare for days 61–90 in a benefit period.
  • You may use up to 60 lifetime reserve days at a per-day charge set by Medicare for days 91–150 in a benefit period.
  • You pay 100 percent of the cost for day 150 and beyond in a benefit period.

Your inpatient rehab coverage and costs may be different with a Medicare Advantage plan, and some costs may be covered if you have a Medicare supplement plan. Check with your plan provider for details.

For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

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