How Long Does Medicare Cover Rehab After Hospital Stay?

Medicare, the federal health insurance program for individuals aged 65 or older, and certain younger people with disabilities or specific conditions, offers coverage for various post-hospital rehabilitation needs.

Understanding Medicare’s Criteria for Post-Hospital Rehab Coverage

To qualify for Medicare coverage of rehabilitation services after a hospital stay, individuals generally need to have Medicare Part A, which is hospital insurance. Most people qualify for premium-free Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). If this work history requirement is not met, a monthly premium for Part A may apply.

A crucial criterion for Skilled Nursing Facility (SNF) coverage is a “qualifying hospital stay.” This means a medically necessary inpatient hospital stay of at least three consecutive days. The count begins on the day of admission as an inpatient, but does not include the day of discharge. Time spent in the emergency room or under observation status, even if overnight, does not count toward this three-day inpatient requirement.

Following the qualifying hospital stay, admission to a Medicare-certified SNF typically needs to occur within 30 days of hospital discharge. The patient must require daily skilled nursing care or therapy services, which are services that can only be performed or supervised by professional personnel like registered nurses or licensed therapists. These services must be medically necessary for a condition treated during the hospital stay or a new condition that arose while receiving SNF care.

The Duration of Medicare Skilled Nursing Facility (SNF) Coverage

Medicare Part A coverage for Skilled Nursing Facility (SNF) care is structured around what is known as a “benefit period.” A benefit period begins the day an individual is admitted as an inpatient to a hospital or SNF and ends when they have not received inpatient hospital care or Medicare-covered skilled care in an SNF for 60 consecutive days. There is no limit to the number of benefit periods an individual can have, though a new Part A deductible applies with each new benefit period.

Within each benefit period, Medicare covers up to 100 days of SNF care. The financial responsibility for these days is divided into distinct phases. For the first 20 days of a Medicare-covered SNF stay, Medicare Part A covers 100% of approved services, with no copayment.

Following the initial 20 days, a daily copayment is required for days 21 through 100. For 2025, this daily copayment is $209.50. After day 100 within a benefit period, Medicare coverage for SNF care ceases, and the individual becomes responsible for all costs. If a break in skilled care lasts for at least 60 days, the current benefit period ends, and a new one can begin, potentially renewing eligibility for up to 100 days of SNF benefits after another qualifying hospital stay.

Inpatient Rehabilitation Facility (IRF) and Home Health Coverage

Beyond skilled nursing facilities, Medicare also provides coverage for rehabilitation in Inpatient Rehabilitation Facilities (IRFs) and for home health services following a hospital stay. IRFs are designed for individuals who require intensive rehabilitation services, typically needing at least three hours of therapy per day from multiple disciplines, such as physical, occupational, and speech therapy. Admission to an IRF requires a physician’s order and a medical need for intensive rehabilitation, with physician supervision.

Medicare Part A covers IRF stays, similar to inpatient hospital care, within the framework of a benefit period. This means that after meeting the Part A deductible, Medicare pays for the initial days of an IRF stay, with coinsurance amounts applying for later days within the benefit period. The specific daily coinsurance for IRFs differs from SNFs and is generally aligned with hospital coinsurance amounts, such as $419 per day for days 61-90 in 2025. Coverage continues as long as the patient requires and actively participates in the intensive rehabilitation program.

For individuals who can receive care at home, Medicare Part A and/or Part B may cover home health services. Eligibility requires that a person be “homebound,” meaning it is difficult to leave home without assistance, and they need intermittent skilled nursing care or therapy services. Covered services can include skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and part-time home health aide services if skilled care is also being received. Medicare typically covers 100% of approved home health services with no copayment, though a 20% coinsurance may apply for durable medical equipment.

Practical Steps and What to Expect

Navigating post-hospital rehabilitation requires proactive engagement with healthcare providers and an understanding of Medicare regulations. Hospital discharge planners are instrumental in coordinating post-hospital care, helping to identify suitable facilities and services based on medical needs and insurance coverage. They can provide information and assist with transitions to SNFs, IRFs, or home health.

Patients should clarify their admission status with hospital staff, as it directly impacts their eligibility for post-hospital benefits. Ensuring that medical documentation accurately reflects the medical necessity of skilled services is also important for coverage.

If Medicare coverage for services is denied or ends, individuals have the right to appeal the decision. The appeals process involves several levels, and patients can submit supporting documentation from their doctors. Additionally, beneficiaries should review their Explanation of Benefits (EOB) statements from Medicare Advantage or Part D plans, or Medicare Summary Notices (MSNs) from Original Medicare, to monitor services and costs and identify any discrepancies. These documents are summaries, not bills, but they are important for understanding how services were covered and for initiating an appeal if needed.