What to Do When Medicare Runs Out for Rehab?
Discover practical solutions for continued rehabilitation care once Medicare coverage concludes. Explore diverse funding and support pathways for your recovery.
Navigating healthcare funding for rehabilitation, especially when needs extend beyond initial coverage, is a significant concern. This article provides a comprehensive guide to options for securing ongoing rehabilitation once primary Medicare benefits are exhausted.
Understanding Medicare Rehabilitation Coverage
Medicare Part A covers medically necessary skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care. For SNF coverage, a qualifying inpatient hospital stay of at least three consecutive days is typically required before admission. The patient must need daily skilled nursing or rehabilitation services that require the expertise of professional personnel.
Medicare Part A covers the full cost for the first 20 days of an SNF stay within a benefit period. A benefit period begins the day a patient is admitted as an inpatient in a hospital or SNF and ends when they have not received inpatient hospital or skilled SNF care for 60 consecutive days. For days 21 through 100 of SNF care, a daily coinsurance applies, which is $209.50 in 2025.
Medicare Part A also covers medically necessary IRF care, often following a serious medical event. Patients admitted to an IRF must require intensive rehabilitation, typically at least three hours of therapy per day for five to seven days a week, and require continued medical supervision. IRF coverage involves a deductible for days 1-60 and a daily coinsurance for days 61-90. After day 100 for SNFs, or after using lifetime reserve days for IRFs, Medicare coverage ceases, and the patient becomes responsible for all costs.
Exploring Other Insurance and Government Programs
When Medicare Part A rehabilitation benefits are exhausted, other insurance and government programs can provide financial relief. Medigap (Medicare Supplement Insurance) helps cover some out-of-pocket costs not paid by Original Medicare. Most Medigap plans (C, D, F, G, M, N) can cover the daily coinsurance for SNF stays from days 21 through 100. Medigap plans do not cover long-term custodial care.
Medicare Advantage (Part C) plans, offered by private companies, must cover at least the same benefits as Original Medicare. They may offer additional rehabilitation services or different cost-sharing structures, potentially including extended SNF days. Individuals should review their plan’s “Summary of Benefits” to understand their rehabilitation coverage.
Medicaid serves as a payer of last resort for long-term care and rehabilitation for individuals with limited income and assets. Eligibility varies by state, generally involving specific income and asset limits. Medicaid can cover skilled nursing care and, in some instances, home- and community-based services, provided the individual meets the state’s medical necessity criteria.
Eligible veterans can access rehabilitation services through the U.S. Department of Veterans Affairs (VA). The VA offers various services, including skilled nursing care, home healthcare, and outpatient rehabilitation. Eligibility for VA benefits depends on service history, discharge status, and a service-connected disability rating. Some states and localities also have programs to assist seniors or individuals with disabilities in covering rehabilitation costs.
Utilizing Personal Financial Resources
When insurance and government programs do not fully cover rehabilitation expenses, individuals often turn to personal financial resources. Using savings and investments, such as liquid assets, savings accounts, and investment portfolios, is a direct way to cover ongoing care costs without external approvals or application processes.
Home equity can be a significant financial resource for long-term care. A reverse mortgage allows homeowners, typically aged 62 and older, to convert home equity into cash without selling. Funds can be received as a lump sum, monthly payments, or a line of credit. Repayment is typically due when the last borrower sells, permanently moves out, or passes away.
Long-term care insurance covers extended care services, including skilled nursing, assisted living, and home care. These policies activate after a waiting period and can provide substantial financial assistance for costs not covered by Medicare or other programs. Family contributions can also play a role, with members providing financial support or sharing the cost of care.
Negotiating payment plans directly with rehabilitation facilities or providers can help manage costs. Many facilities may be open to flexible financial arrangements. Utilizing health savings accounts (HSAs) or flexible spending accounts (FSAs) can also help manage rehabilitation costs using pre-tax dollars.
Navigating Continued Care and Support
Once funding options are understood, the next step involves navigating continued care. A thorough assessment of the patient’s physical, cognitive, and functional needs determines the most appropriate level of care. This evaluation helps decide if skilled nursing, assisted living, home health services, or outpatient therapy best suits the individual’s recovery.
Locating appropriate providers involves identifying facilities or home health agencies that accept chosen payment methods. This includes finding Medicaid-certified facilities, providers within a Medicare Advantage network, or facilities that primarily accept private pay. Online resources and healthcare directories can assist in this search.
Understanding contracts and associated costs is important. Carefully review facility contracts, daily rates, and any potential extra charges to avoid unexpected expenses. This ensures transparency regarding the financial commitment for ongoing care.
Advocacy and support resources help navigate these transitions. Professionals such as elder care attorneys, social workers, and case managers provide guidance. Social workers play a significant role in discharge planning, linking patients with community resources, and offering emotional support during care transitions. These professionals help ensure continuity of care and address psychosocial aspects of moving between different care settings.