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Medicare coverage for inpatient rehab
You can get coverage for rehab through Medicare Part A if it is medically necessary. With this coverage, you may be able to get:
- Inpatient rehabilitation services
- A semi-private room
- Meals
- Nursing services
- Prescription drugs
- Other hospital services and supplies
Be sure to review your plan details. There, you can see if you meet the criteria for inpatient rehabilitation with your Medicare Part A rehab coverage.
Medicare criteria for inpatient rehab
You need to meet certain requirements to get coverage. First, you need to be enrolled in Medicare. Next, your doctor must certify that you meet the following Medicare rules to qualify:
- You need intensive rehabilitation
- You need continued medical supervision
- You need coordinated care from doctors, therapists and other health care providers
How much does inpatient rehabilitation cost with Original Medicare?
Your rehab costs depend upon the type of facility and the length of your stay.
Medicare coverage for rehab allows an unlimited number of stays at an inpatient rehab facility. But only the first 60 days of each stay are fully covered. You pay $0 during that period after your Part A deductible is met. From days 61 to 90, your costs then become $419 per day. Days 91 and beyond are called “lifetime reserve days.” You pay $819 for each of these days, up to 60 days over your lifetime. You pay the full cost for these days after you reach 60 lifetime reserve days.
If you rehab in a skilled nursing facility, 100 days are covered per benefit period. During your first 20 days, you pay $0 after your Part A deductible is met. From days 21 to 100, you pay $209.50 per day. Beyond day 100, you pay all costs.
For either type of facility, you must first have a medically necessary inpatient hospital stay of at least 3 days in a row.
How much does it cost with Medicare Advantage?
With Medicare Advantage, rehab costs vary depending on your specific plan. You can learn more by discussing Medicare Advantage costs with your provider before beginning care. Explore Medicare Advantage Special Needs Plans if you think you might need long-term care. You may be eligible for an Institutional Special Needs Plan (I-SNP) if you need to stay in a skilled nursing facility for 90 days or longer.
How much does it cost with a Medicare Supplement plan?
Medicare Supplement plans (Medigap) may help with rehab costs like coinsurance and your deductible. You may also get extra lifetime reserve days, depending on your plan. Learn more about Medicare Supplement plans.