Does Medicare Pay for Rehab After Surgery?

Medicare, the federal health insurance program, covers millions of Americans, primarily those aged 65 or older, and certain younger individuals with disabilities. It assists with healthcare costs like hospital stays, doctor visits, and prescription medications. A common question is whether Medicare covers rehabilitation after surgery. It plays an important role in recovery.

Medicare Coverage for Post-Surgery Rehabilitation

Medicare covers various rehabilitation services for post-surgery recovery, with different parts covering specific settings and care types. Medicare Part A, hospital insurance, primarily covers inpatient rehabilitation, including Skilled Nursing Facilities (SNFs) and Inpatient Rehabilitation Facilities (IRFs).

In an SNF, Part A covers skilled nursing, physical, occupational, and speech-language therapy necessary for recovery from a hospital stay. IRFs provide intensive rehabilitation for patients needing interdisciplinary care, focusing on improving function and helping them return home or to a lower level of care.

Medicare Part B, medical insurance, covers outpatient rehabilitation, including physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) in various settings. Patients can receive these services at outpatient clinics, hospital outpatient departments, or, under specific conditions, at home. These therapies aim to restore function, reduce pain, and prevent disability after surgery.

Medicare Part C, or Medicare Advantage Plans, are offered by private companies approved by Medicare and must cover all services Original Medicare (Parts A and B) covers. While providing the same benefits, Medicare Advantage plans may have different rules, provider networks, and cost-sharing. Beneficiaries should consult their plan documents for rehabilitation coverage.

Criteria for Medicare Rehabilitation Coverage

Medicare covers post-surgery rehabilitation when specific conditions are met, ensuring services are appropriate and medically necessary. “Medical necessity” means a doctor must prescribe services reasonable and necessary for treating an illness or injury, or to improve a body part’s functioning, directly supporting the patient’s recovery goals.

Another criterion is “skilled care.” Care must be skilled nursing or skilled therapy performed by, or under the direct supervision of, qualified therapists or medical professionals. This distinguishes covered rehabilitation from custodial care or non-skilled assistance, which Medicare generally does not cover. Services must be complex enough to require professional oversight.

For Medicare Part A coverage of Skilled Nursing Facility (SNF) care, a “3-day inpatient hospital stay” rule often applies. A patient must be admitted as an inpatient for at least three consecutive days before transfer to an SNF. Observation stays typically do not count toward this three-day requirement. A doctor’s order or an established plan of care is also required for all covered rehabilitation services, regardless of the setting.

Patient Financial Responsibilities

Understanding out-of-pocket costs for post-surgery rehabilitation is important. For inpatient rehabilitation covered by Medicare Part A, such as Skilled Nursing Facilities (SNFs) or Inpatient Rehabilitation Facilities (IRFs), a deductible applies. In 2025, the Medicare Part A deductible is $1,676 per benefit period, covering the first 60 days of inpatient hospital care.

After the deductible is met, coinsurance for SNF stays varies based on length of stay. For the first 20 days in an SNF, Medicare Part A covers the full cost, with no coinsurance. From day 21 through day 100, the daily coinsurance is $209.50 in 2025. Beyond 100 days, Medicare Part A generally ceases coverage, and the patient becomes responsible for the full amount.

For outpatient rehabilitation covered by Medicare Part B, such as physical or occupational therapy, an annual deductible applies. In 2025, the Medicare Part B deductible is $257. Once satisfied, beneficiaries typically pay 20% of the Medicare-approved amount for most Part B-covered services, including outpatient therapy. Medicare Advantage plans (Part C) may have different cost-sharing rules, including varying deductibles, copayments, or coinsurance, so reviewing the specific plan’s benefits is necessary.

Navigating Your Rehabilitation Journey with Medicare

Navigating rehabilitation with Medicare requires proactive engagement and clear communication. Discuss post-surgery rehabilitation needs with doctors and hospital discharge planners to ensure proper referrals and a comprehensive care plan aligning with Medicare’s coverage requirements.

Before starting rehabilitation, especially with a Medicare Advantage plan, confirm if pre-authorization is required. Contacting your plan directly or having your provider do so can prevent unexpected costs or service denials. Always verify that the rehabilitation facility or therapist you choose participates in Medicare, ensuring they accept Medicare assignment and will bill Medicare directly for covered services.

If a claim for rehabilitation coverage is denied, beneficiaries have the right to appeal Medicare’s decision. The appeals process involves several levels, beginning with a redetermination by Medicare’s claims administrator. Understanding this process and promptly submitting documentation can secure coverage. For further information, consult the official Medicare website or your specific Medicare plan documents.