Does Medicare Cover Rehab After Surgery?

Rehabilitation services are often necessary for recovering from surgery, helping individuals regain strength, mobility, and independence. This article clarifies how Medicare covers post-surgical rehabilitation, detailing the services, settings, and financial considerations involved.

Rehabilitation Services Covered by Medicare

Medicare covers several types of rehabilitation services designed to aid recovery following surgery. For coverage, all services must be medically necessary and provided by licensed professionals as part of a personalized plan of care.

Physical therapy (PT) is a common rehabilitation service focused on improving movement, strength, balance, and reducing pain. This can involve exercises, manual therapy techniques, and mobility training to help patients recover from surgical procedures affecting their musculoskeletal system.

Occupational therapy (OT) assists patients in regaining the skills needed for daily living activities, such as dressing, bathing, and cooking. It helps individuals adapt to new limitations and perform tasks independently, often by focusing on fine motor skills and adaptive equipment use.

Speech-language pathology (SLP) addresses communication and swallowing disorders that may arise after certain surgeries, particularly those involving the head, neck, or neurological systems. Therapists work to improve speech clarity, language comprehension, and safe swallowing mechanisms.

Where Rehabilitation is Covered

Post-surgical rehabilitation services can be received in various settings, each providing different levels of care. The specific setting depends on the patient’s medical needs and the intensity of therapy required. Medicare has distinct rules for coverage in each environment.

Skilled Nursing Facilities (SNFs) provide short-term, skilled nursing care and therapy after a hospital stay. Patients require daily skilled services, such as intravenous injections or complex wound care, along with rehabilitation therapies. SNF coverage requires a prior inpatient hospital stay of at least three consecutive days, and admission generally must occur within 30 days of hospital discharge.

Inpatient Rehabilitation Facilities (IRFs), also known as acute rehabilitation hospitals, offer intensive, coordinated rehabilitation programs. These facilities suit patients with complex conditions who can benefit from a higher level of therapy. To qualify for IRF care, a physician must certify the need for intensive rehabilitation, continued medical supervision, and coordinated care from a multidisciplinary team. This typically means at least three hours of therapy per day, five days a week, or fifteen hours over seven consecutive days.

Home health services allow rehabilitation therapies like physical, occupational, and speech-language therapy to be provided in a patient’s home. This option is for individuals considered “homebound,” meaning they have difficulty leaving home without assistance due to illness or injury. Home health care also requires a need for intermittent skilled nursing care or therapy services.

Outpatient therapy centers and clinics offer rehabilitation services where the patient travels to the facility for appointments. This setting includes private practices, hospital outpatient departments, and comprehensive outpatient rehabilitation facilities. Patients needing ongoing therapy after inpatient care can receive services here.

Understanding Medicare’s Role in Coverage

Medicare’s coverage for rehabilitation services is managed through two main parts: Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Each part covers different types of services and settings, with specific criteria for eligibility and duration of coverage.

Medicare Part A covers inpatient rehabilitation services received in Skilled Nursing Facilities (SNFs) and Inpatient Rehabilitation Facilities (IRFs). For SNFs, Part A provides full coverage for the first 20 days of a benefit period. From day 21 to day 100, a daily coinsurance applies. Beyond 100 days in an SNF during a benefit period, Medicare Part A ceases coverage, making the patient responsible for all costs.

For IRFs, Medicare Part A covers comprehensive, intensive rehabilitation programs. Part A covers the first 60 days of an IRF stay within a benefit period with a deductible, followed by a daily coinsurance for days 61 through 90. Beneficiaries also have 60 “lifetime reserve days” that can be used after day 90, each with a higher daily coinsurance.

Medicare Part B primarily covers outpatient therapy services, including physical, occupational, and speech-language pathology, received in settings like clinics, hospital outpatient departments, and private practices. Part B also covers certain home health services. For Part B services, a physician’s order and a plan of care are required. Claims exceeding a certain threshold are subject to targeted medical review to confirm medical necessity.

Patient Financial Responsibilities

Medicare beneficiaries incur out-of-pocket costs, including deductibles and coinsurance. These costs vary depending on the type of service and where it is received.

For Medicare Part A services, such as inpatient hospital stays or Skilled Nursing Facility (SNF) care, a deductible applies for each benefit period. In 2025, the Part A deductible is $1,676. After this deductible, SNF stays incur no coinsurance for the first 20 days. From day 21 to day 100, a daily coinsurance of $209.50 applies in 2025. Beyond 100 days, the patient is responsible for all costs.

Medicare Part B services, including most outpatient therapies, have an annual deductible. In 2025, the Part B deductible is $257. Once met, patients are typically responsible for a 20% coinsurance of the Medicare-approved amount for covered services. Medicare pays the remaining 80%.

Services not deemed medically necessary or provided in non-covered settings will not be covered by Original Medicare, making the patient responsible for the full cost. If a patient has a Medicare Advantage plan, their costs and coverage rules may differ, and they should contact their plan provider directly.