Does Medicare Cover Rehab After a Hospital Stay?

Medicare offers financial support for rehabilitation services following a hospital stay. Understanding its specific coverage, criteria, and potential financial responsibilities is crucial for planning post-hospital care.

Understanding Medicare’s Scope for Rehabilitation

Medicare covers several types of rehabilitation services to help patients regain function and independence after an illness or injury requiring hospitalization. The specific setting and nature of care determine which part of Medicare applies.

Skilled Nursing Facilities (SNFs) provide short-term, skilled nursing care or therapy services after a hospital stay. These facilities offer care from registered nurses, doctors, and therapists for conditions like wound care, physical therapy, or intravenous medication administration. Medicare Part A typically covers these services for eligible beneficiaries.

Inpatient Rehabilitation Facilities (IRFs), often part of a hospital or a standalone facility, deliver intensive rehabilitation programs. These programs are for patients who require a higher level of therapy, usually at least three hours per day, provided by multiple therapy disciplines like physical, occupational, and speech therapy. Medicare Part A also covers services provided in IRFs.

Home Health Services (HHS) allow patients to receive necessary skilled care in their own homes. This can include skilled nursing care, physical therapy, occupational therapy, or speech-language pathology services. While primarily covered under Medicare Part B, some home health care can be covered under Part A if it follows a qualifying hospital or SNF stay.

Outpatient Therapy encompasses rehabilitation services received at a clinic, physician’s office, or hospital outpatient department. These services, such as physical, occupational, or speech therapy, are generally covered by Medicare Part B. Outpatient therapy helps individuals improve or restore physical function and is often utilized for ongoing recovery after discharge from an inpatient setting.

Key Requirements for Coverage

Medicare coverage for rehabilitation after a hospital stay requires meeting specific criteria, ensuring that services are medically necessary and provided in the appropriate setting. A primary requirement for Skilled Nursing Facility (SNF) care and some Home Health Services under Part A is a “qualifying hospital stay.” This means the patient must have been admitted as an inpatient for at least three consecutive days, not including the day of discharge. Time spent under observation status does not count toward this three-day inpatient requirement.

Following the qualifying hospital stay, the patient must generally enter the SNF within 30 days of leaving the hospital. For SNF, Inpatient Rehabilitation Facility (IRF) care, and all types of therapy, services must be “medically necessary.” This means a physician or other qualified healthcare professional must order the care, and it must be a specific and effective treatment for the patient’s condition, aiming to improve, maintain, or prevent decline.

Another requirement is the need for “daily skilled care,” referring to services that can only be provided by, or under the supervision of, skilled nursing or therapy staff. For instance, skilled therapy services typically need to be provided five days per week. The care provided must be directly related to the condition for which the patient was hospitalized or a new condition that arose while receiving care for the initial condition.

Your Financial Responsibility

Understanding your financial obligations for Medicare-covered rehabilitation services after a hospital stay is important for planning your recovery. For Skilled Nursing Facility (SNF) care, Medicare Part A covers the full cost for the first 20 days of each benefit period, provided all eligibility criteria are met. From day 21 through day 100 in a benefit period, you are responsible for a daily coinsurance amount. In 2025, this daily coinsurance for SNF care is $209.50. After day 100, Medicare Part A no longer covers SNF costs, and you become responsible for all charges.

For Inpatient Rehabilitation Facility (IRF) stays, which are also covered under Medicare Part A, your financial responsibility aligns with inpatient hospital costs within a benefit period. In 2025, the Part A inpatient hospital deductible is $1,676 per benefit period. You pay $0 for the first 60 days of inpatient care after meeting this deductible.

For days 61 through 90, a daily coinsurance of $419 applies. Beyond day 90, Medicare provides 60 lifetime reserve days, each incurring a coinsurance of $838 per day. Once lifetime reserve days are exhausted, you are responsible for all costs.

Outpatient Therapy and Home Health Services (when covered by Part B) have different cost-sharing rules. The standard Medicare Part B annual deductible for 2025 is $257. After meeting this deductible, you typically pay a 20% coinsurance of the Medicare-approved amount for services. While there is an annual therapy threshold for outpatient therapy services, services exceeding these amounts can still be covered if medically necessary, though they may be subject to targeted medical review.

Accessing and Managing Your Benefits

Accessing Medicare rehabilitation benefits typically begins within the hospital setting, often guided by discharge planners. These professionals work with patients, families, and the medical team to determine appropriate post-hospital care options and facilitate transitions. They assist in arranging referrals to Medicare-approved facilities or home health agencies.

A physician’s order and a detailed care plan are required for Medicare to cover rehabilitation services. The care plan outlines the specific therapies, frequency, and duration of care. The care provided must align with this physician-certified plan of care to ensure continued coverage.

During a Medicare-covered stay in a Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF), beneficiaries receive a “Notice of Medicare Non-Coverage” (NOMNC) when their covered services are ending. This notice informs you that Medicare will no longer pay for your care and explains your rights, including how to appeal the decision. The NOMNC must be provided at least two calendar days before covered services end, or on the second to last day of service if care is not provided daily.