How Many Days Does Medicare Pay for Rehab?

Rehabilitation plays an important role in helping individuals recover and regain function after an illness, injury, or surgery. Understanding how Medicare covers these services is important for patients and families. Medicare provides coverage for various rehabilitation settings, but the extent depends on specific criteria and the type of facility. This article outlines Medicare’s framework for rehabilitation coverage.

Medicare’s Definition of Rehab Coverage

Medicare’s coverage for rehabilitation services focuses on medically necessary care aimed at improving or restoring function, or preventing further deterioration. These services include physical therapy, occupational therapy, and speech-language pathology. A physician must order these services, and qualified therapists must provide them, aligning with accepted medical practice standards.

Medical necessity is a requirement across all rehabilitation settings. Services must be reasonable and necessary for diagnosing or treating an illness or injury. The amount, frequency, and duration of planned services must be appropriate for the patient’s condition. Medicare Part A covers inpatient care, including skilled nursing facilities and inpatient rehabilitation facilities. Medicare Part B covers outpatient services, including some home health care and outpatient therapy.

Skilled Nursing Facility (SNF) Rehab Coverage

Medicare Part A covers rehabilitation services in a Skilled Nursing Facility (SNF) if specific conditions are met. A qualifying hospital stay is necessary: the beneficiary must have been admitted as an inpatient to a hospital for at least three consecutive days before SNF admission. The day of hospital discharge is not counted.

SNF coverage operates within a “benefit period,” which begins the day a beneficiary is admitted as an inpatient to a hospital or SNF. A new benefit period starts if the beneficiary has been out of a hospital or SNF for at least 60 consecutive days. For the first 20 days of a Medicare-covered SNF stay within a benefit period, Medicare covers 100% of the costs. For days 21 through 100, a daily co-insurance of $209.50 applies in 2025. After day 100 of SNF care in a benefit period, Medicare coverage ceases, and the beneficiary is responsible for all costs, with continued coverage contingent on ongoing medical necessity.

Inpatient Rehabilitation Facility (IRF) and Home Health Rehab Coverage

Medicare Part A covers rehabilitation services in an Inpatient Rehabilitation Facility (IRF). Unlike SNFs, IRF coverage does not have a fixed daily limit. Instead, coverage is based on the medical necessity for intensive, coordinated rehabilitation services within an inpatient hospital setting. Patients admitted to an IRF require and can tolerate an intensive rehabilitation program, which often involves at least three hours of therapy per day, five days a week, or 15 hours per week. However, Medicare clarifies that denials are not based solely on not meeting a therapy time threshold, but on clinical judgment of medical necessity.

Home health rehabilitation services are covered under Medicare Part A and/or Part B. This covers medically necessary skilled care provided in the beneficiary’s home by qualified professionals, such as physical therapists, occupational therapists, and speech-language pathologists. To qualify for home health services, a beneficiary must be considered “homebound,” meaning it is difficult to leave home without assistance or leaving home is not advisable due to their condition. Leaving home for medical appointments or short, infrequent non-medical absences does not disqualify a person from being homebound. Coverage for home health is for necessary visits, not a fixed number of days, and requires a doctor’s order and a plan of care.

Financial Responsibility and Appeals

Beneficiaries have financial responsibilities for rehabilitation services not fully covered by Medicare, including deductibles and co-insurance. For instance, the Medicare Part A deductible for inpatient hospital stays, which can apply before SNF or IRF coverage, is $1,676 per benefit period in 2025. For SNF care, the daily co-insurance of $209.50 for days 21-100 applies. When Medicare coverage ends, whether due to reaching day limits or a determination that care is no longer medically necessary, the beneficiary becomes responsible for the full cost of continued care.

Supplemental insurance, such as Medigap policies or Medicare Advantage plans, can help cover some of these out-of-pocket costs. Medigap plans work with Original Medicare to cover deductibles, co-insurance, and co-payments. Medicare Advantage plans, provided by private companies, offer an alternative to Original Medicare and may have different cost-sharing structures, often with an annual out-of-pocket maximum.

If Medicare denies coverage for rehabilitation services or determines that services are no longer necessary, beneficiaries have the right to appeal the decision. Hospitals and other providers are required to issue a “Notice of Medicare Non-Coverage” explaining the decision and the appeals process. A common first step is to request a “fast appeal” through a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), an independent reviewer. This process allows for a rapid review of the medical necessity determination, and understanding the appeals process is important for beneficiaries.