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.
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.
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.
For Medicare to pay for your stay in an intensive inpatient rehabilitation center, your doctor must certify that you need:
People who qualify for Medicare rehab coverage often need:
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to improve enough to enable you to return home on your own, or to your prior level of functioning, but this rule is no longer in effect.
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.
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).
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.
When you're admitted to an IRF, Medicare Part A hospital insurance will cover the following, for a certain amount of time:
Medicare Part A hospital insurance doesn't cover:
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.
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:
Updated July 13, 2022