Medicare Part A covers most of the cost of care when you stay at an inpatient rehabilitation facility (sometimes called a rehabilitation hospital). Your doctor may send you to an inpatient rehabilitation facility if you are recovering from major surgery such as bilateral hip replacement or a serious injury or illness such as a stroke or spinal cord injury and you require a team of medical professionals and intensive therapy to help you recover.
An inpatient rehab facility (IRF) is sometimes called an acute care rehabilitation center. An IRF can be a separate wing of a hospital or can be a stand-alone rehabilitation hospital. IRFs provide intensive, multi-disciplinary physical or occupational therapy under the supervision of a doctor as well as full-time skilled nursing care.
Skilled nursing facilities sometimes call themselves post-acute rehabilitation centers, but they are not IRFs. The rules for a Medicare-covered stay in a skilled nursing facility are very different; see our article on Medicare coverage for skilled nursing facilities.
For Medicare to pay for your stay in an intensive inpatient rehabilitation center, your doctor must certify that you need:
Medicare cannot deny coverage because your condition is not expected to improve enough to enable you to return home or to your prior level of functioning.
If you don't need intensive rehabilitation, but you do need full-time nursing care, Medicare Part A could cover a stay in a skilled nursing facility instead. Or, if you don't need intensive rehab and you only need part-time nursing care, Medicare could cover home health care visits. For more information, see our articles on Medicare coverage of skilled nursing facilities and Medicare coverage of home health care.
Medicare Part A reimburses stays at an inpatient rehabilitation facility in the same way as it reimburses regular hospital stays; in other words, you will have the same out-of-pocket costs. Accordingly, Medicare pays only certain amounts of your stay at an IRF. For the first 60 days you are an inpatient in an IRF, Part A hospital insurance pays for everything. After your 60th day in an IRF, and through your 90th day, you must pay a daily co-pay $296 (in 2013).
If you are in an IRF more than 90 days (during one spell of illness), you can use up to 60 additional "lifetime reserve" days of coverage. During those days, you are responsible for a daily coinsurance payment of $592 per day, in 2013, and Medicare will pay the rest. You have only 60 reserve days to be used over your whole lifetime, for both hospital and IRF stays combined.
There is no requirement that you first stay in a regular hospital for a certain number of days (as with Medicare coverage of skilled nursing facilities), but if you don't, you will need to pay the Part A deductible of $1,184 (in 2013).
If you are transferred from an acute care hospital, the deductible you pay for the hospital stay counts for the rehabilitation stay as well.
When you are admitted to an IRF, Medicare Part A hospital insurance will cover the following for a certain amount of time:
Medicare Part A hospital insurance does not cover:
Whether you are transferred to an IRF or a skilled nursing facility is an important distinction because Medicare covers a different number of days for an IRF than it does for skilled nursing, and you pay a different co-payment. In addition, Medicare compensates the facility differently. To be compensated by Medicare as an IRF, the facility must be approved by Medicare and at least 60% of cases an IRF admits have one or more of the following conditions: