Medicare Coverage for Inpatient Physical Rehabilitation
What is rehabilitation?
Rehabilitation is a treatment program for people who have been ill or injured. It helps them relearn the skills of everyday life In rehab, people may learn new ways to:
- eat, cook, dress, or bathe
- exercise to improve your strength and balance
- improve your ability to remember things or solve problems
- listen, read, speak, and write.
When is rehab needed?
You may need rehab if you have had:
- a stroke or other type of paralysis
- broken bones that make it hard to do everyday tasks
- a hand injury or surgery
- joint replacement surgery
- vision problems such as blindness.
What is Medicare?
Medicare is a federal government program. It provides healthcare coverage for people 65 or older, or for people of any age who have certain disabilities.
Medicare is divided into 2 parts: Part A and Part B. Each part covers different services. Both parts pay some of the costs for needed medical services. Both parts pay toward home healthcare if certain conditions are met.
Medicare Part A covers:
- inpatient hospital care
- skilled nursing facilities
- hospice care.
Medicare Part B covers:
- doctor visits
- lab and X-ray services
- durable medical equipment
- ambulance services
- outpatient hospital care.
Rules about what Medicare covers can be confusing. Rules also change from time to time. The premium (monthly amount of money you pay) for Medicare Part B can change every January. The deductibles (what you must pay before Medicare begins to pay), and the copayments (the percentage of costs you must pay) may also change. Your local Social Security office can answer your questions about Medicare.
Does it cover rehabilitation?
Rehabilitation in a hospital rehab unit is covered under Medicare Part A. Medicare may pay for rehab in a skilled nursing facility under certain conditions.
After you have been in a hospital for at least 3 days, Medicare will pay for inpatient rehabilitation for up to 100 days in a benefit period. A benefit period begins when you go into the hospital. It ends when you have not received any hospital care or skilled nursing care for 60 straight days.
Medicare pays for the first 20 days at 100%. For the next 80 days, you must pay a daily coinsurance amount. Medicare does not pay for rehab after 101 days.
If you go into the hospital (for at least 3 days) after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.
For information on coverage for outpatient rehabilitation, see:
Call Medicare toll-free at 1-800-638-6833.
