How Long Will Medicare Pay for Rehab?

Medicare covers rehabilitation services for recovery from illness, injury, or surgery. Coverage duration and conditions depend on the rehabilitation setting and medical necessity. Understanding these nuances helps beneficiaries.

Medicare Part A Coverage for Inpatient Rehabilitation

Medicare Part A covers inpatient rehabilitation services provided in settings such as Skilled Nursing Facilities (SNFs) and Inpatient Rehabilitation Facilities (IRFs). Inpatient rehabilitation is designed for individuals requiring intensive therapy and medical supervision after an acute event. This coverage includes services like physical, occupational, and speech-language therapy, along with a semi-private room, meals, nursing care, and prescription drugs received during the stay.

For coverage in a Skilled Nursing Facility, Medicare requires a qualifying hospital stay of at least three consecutive inpatient days. Observation stays do not count towards this “3-day rule,” and the patient must be formally admitted to the hospital by a doctor’s order. Once this criterion is met, coverage for SNF care is structured around a “benefit period,” which begins the day a person is admitted as an inpatient to a hospital or SNF and ends when they have been out of such a facility for 60 consecutive days.

Within each benefit period, Medicare Part A provides full coverage for the first 20 days in a Skilled Nursing Facility, following the satisfaction of the Part A deductible. For days 21 through 100, beneficiaries are responsible for a daily coinsurance, which is $209.50 per day in 2025. Beyond 100 days within a single benefit period, Medicare Part A ceases to cover skilled nursing facility care.

Inpatient Rehabilitation Facilities (IRFs) cover intensive rehabilitation for conditions like stroke or spinal cord injury. To qualify, a doctor must certify the need for intensive rehabilitation, continued medical supervision, and coordinated care. Unlike SNFs, IRFs do not have a strict 100-day limit, but coverage duration is still determined by medical necessity. For IRF stays, after meeting the Part A deductible, there is no coinsurance for the first 60 days, followed by a daily coinsurance of $419 for days 61-90 and $838 for lifetime reserve days (up to 60 days) from day 91 onward in 2025.

Medicare Part B Coverage for Outpatient Rehabilitation

Medicare Part B provides coverage for rehabilitation services received on an outpatient basis, encompassing physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP). These services can be rendered in various settings, including a therapist’s office, an outpatient hospital department, or even within the home if specific home health criteria are met. Part B coverage for these therapies relies on them being deemed medically necessary and supported by a physician’s order or a certified plan of care.

Part B outpatient therapy has no fixed “days” limit, unlike inpatient care. Coverage continues as long as the services are considered medically necessary for the patient to make progress in their recovery or to maintain their current functional level. Services must be delivered by a Medicare-certified therapist or facility to be covered.

While there is no longer an annual financial cap on outpatient therapy services, Medicare does implement a threshold amount. For 2025, once the combined costs for physical therapy and speech-language pathology reach $2,410, or occupational therapy costs reach $2,410 separately, the provider must confirm the medical necessity of continuing services through documentation. Medicare will continue to cover services beyond these thresholds if the medical necessity is properly substantiated.

Understanding Your Share of Rehabilitation Costs

Beneficiaries are responsible for certain financial contributions when Medicare covers rehabilitation services. For inpatient care under Medicare Part A, an annual deductible applies to each benefit period, which is $1,676 in 2025.

For outpatient rehabilitation services covered by Medicare Part B, an annual deductible must first be met, set at $257 for 2025. After the deductible is satisfied, Medicare generally pays 80% of the Medicare-approved amount for most outpatient therapy services. The beneficiary is then responsible for the remaining 20% coinsurance.

Supplemental insurance options, such as Medigap (Medicare Supplement) plans or Medicare Advantage (Part C) plans, can impact these out-of-pocket costs. These plans may help reduce or eliminate the patient’s share of deductibles and coinsurance, though the specific benefits and cost structures vary significantly by plan and insurer.

Navigating Continued Rehabilitation Needs

When Medicare coverage for rehabilitation ends, patients must consider continued care options. In such situations, healthcare providers are obligated to issue an Advance Beneficiary Notice of Noncoverage (ABN) if they believe services will not be covered because they are not medically reasonable or necessary. This notice informs the patient that they may have to pay for the services out-of-pocket. One option for continued rehabilitation is private pay, where the patient directly covers the full cost of services.

Patients may also explore other existing health insurance policies they hold, as some plans might offer coverage for rehabilitation services beyond Medicare’s limits. For individuals with limited income and resources, Medicaid may offer assistance, potentially covering long-term care or rehabilitation services, depending on specific eligibility criteria.

If a beneficiary disagrees with a Medicare coverage decision or the termination of services, they have the right to file an appeal. The appeals process involves multiple levels, requiring supporting medical evidence.