Medicare Coverage of Inpatient Rehabilitation Stays

Your doctor may send you to an inpatient rehabilitation facility (sometimes called a rehabilitation hospital) if you require a team of medical professionals and intensive therapy to help you recover from surgery or from a serious illness or injury. For instance, people who are recovering from major surgery, such as bilateral hip replacement, often go to "rehab" facilities for a few days or a few weeks after they're released from the hospital. Other rehab patients include those with a serious injury or illness such as a stroke, traumatic brain injury, spinal cord injury, or extensive burns.

Does Medicare Cover Rehab Facilities?

Medicare Part A covers most of the cost of care when you stay at an inpatient rehabilitation facility to recover from a physical injury or illness. Anyone who's 65 or older can get Medicare Part A coverage, although patients without a long work history may have to pay for the coverage.

What Is an Inpatient Rehabilitation Facility?

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 full-time nursing care and intensive, multi-disciplinary physical or occupational therapy under the supervision of a doctor.

Skilled nursing facilities (SNF) sometimes call themselves post-acute rehabilitation centers, but they are not IRFs. SNFs offer a higher level of nursing care but less therapy than IRFs. (Below, we'll discuss the difference.) The rules for a Medicare-covered stay in an SNF are different than for IRFs; see our article on Medicare coverage for skilled nursing facilities.

Who Qualifies for a Medicare-Paid Stay in a Rehab Facility?

For Medicare to pay for your stay in an intensive inpatient rehabilitation center, your doctor must certify that you need:

• intensive rehabilitation
• continued medical supervision, and
• coordinated care, which comes from your doctors and therapists working together.

People who qualify for Medicare rehab coverage often need:

• full-time access to a skilled rehabilitation nurse
• intensive physical or occupational rehabilitation (often three hours per day, five days per week)
• additional therapy such as speech therapy, occupational therapy, or prosthetics/orthotics, and
• full-time access to a doctor with training in rehabilitation (often three visits per week).

Note that, unlike Medicare coverage of skilled nursing facilities, you don't need to first stay in a regular hospital for a certain number of days to qualify for Medicare rehab coverage at an inpatient facility.

An old rule allowed Medicare to deny you coverage if your condition wasn't expected to improve enough to enable you to return home on your own, or to your prior level of functioning, but this rule is no longer in effect.

Alternatives to Inpatient Rehab Facilities

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 can 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.

How Much Does Inpatient Rehab Cost With Medicare?

Medicare Part A hospital insurance 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.

Medicare pays only certain amounts of your stay at an IRF. The good news is that, for the first 60 days you're an inpatient in an IRF, Medical Part A pays for everything. After your 60th day in an IRF, and through your 90th day, you must pay a daily co-pay of $389 (in 2022).

Do You Have to Pay the Medicare Part A Deductible for Rehab?

Yes, each time you stay in an inpatient rehab facility, you'll need to pay the Part A deductible of $1,556 (in 2022). But if you're transferred from an acute care hospital, the deductible you pay for the hospital stay counts for the rehabilitation stay as well. The same is true if you're admitted to an IRF within 60 days of being discharged from a hospital.

What Does Medicare Cover During an IRF Stay?

When you're admitted to an IRF, Medicare Part A hospital insurance will cover the following, for a certain amount of time:

• a semiprivate room
• all meals
• regular nursing services
• social worker services
• drugs, medical supplies, and appliances furnished by the facility, such as casts, splints, wheelchairs, and
• rehabilitation services, such as physical therapy, occupational therapy, and speech pathology.

What Won't Medicare Cover During an IRF Stay?

Medicare Part A hospital insurance doesn't cover:

• personal convenience items such as television, radio, or telephone
• private duty nurses, or
• a private room, when not medically necessary.

How Long Does Medicare Pay for Rehab?

Medicare pays 100% of your costs for the first two months (60 days) at a rehab facility, and then a portion of your costs for the next month, or 30 days. After that, how many additional days Medicare will pay depends on whether you've used any of your "lifetime reserve" days. You get 60 lifetime reserve days to use over the course of your life, for both hospital and IRF stays combined. So if you're in an IRF for more than 90 days, you can use up to 60 additional reserve days of coverage.

However, if you have to stay longer than 90 days (during one spell of illness or injury), your out-of-pocket costs will go up. When you use lifetime reserve days, you're responsible for a daily coinsurance payment of $778 per day, in 2022. Medicare will pay any remaining costs.

What Does Medicare Consider an IRF?

Rehab facilities and skilled nursing facilities offer similar services, and there's some overlap between the two. But it's important to know whether you're transferred to an IRF or a skilled nursing facility. Medicare covers a different number of days for an IRF than it does for skilled nursing, and you pay a higher co-payment for a rehab facility.

In addition, Medicare compensates the facility differently. According to Medicare guidelines for inpatient rehabilitation facilities, to be compensated by Medicare as an IRF, the facility must be approved by Medicare and at least 75% of the patients whom an IRF admits must have one or more of the following conditions:

• stroke
• traumatic brain injury
• spinal cord injury
• burns
• amputation
• major multiple traumas
• hip fracture
• knee or hip replacement, if the patient had two knees or two hips replaced or is morbidly obese or age 85 or older
• a neurological disorder such as Parkinson's, MS, muscular dystrophy, or motor neuron disease, or
• certain forms of osteoarthritis, rheumatoid arthritis, or psoriatic arthritis that impair your ability to walk and take care of yourself.

_{Updated July 13, 2022}