Understanding Medicare Rehab Coverage
Medicare's coverage for inpatient rehabilitation depends heavily on the type of facility providing the care and the patient's specific medical needs. It is important to distinguish between two primary settings: an Inpatient Rehabilitation Facility (IRF) and a Skilled Nursing Facility (SNF), as the coverage periods and rules for each are distinct. Medicare Part A is the portion of Original Medicare that covers inpatient hospital stays, including care in these rehab settings.
Inpatient Rehabilitation Facility (IRF) Coverage
For an IRF, Medicare Part A offers a total of 90 days of coverage per benefit period, plus an additional 60 lifetime reserve days. A benefit period begins the day you are admitted as an inpatient and ends once you have not received inpatient care for 60 consecutive days. If you are readmitted after a benefit period ends, a new one begins, with a new deductible. However, if you are readmitted within the same benefit period, you do not pay the deductible again.
Here is a breakdown of the cost structure for an IRF per benefit period:
- Days 1–60: Covered by Medicare after you pay the Part A deductible.
- Days 61–90: You pay a daily coinsurance.
- Days 91 and beyond: You pay a higher daily coinsurance for each of your 60 lifetime reserve days.
- After reserve days are exhausted: You are responsible for all costs.
Qualifying for an IRF Stay
To qualify for Medicare coverage in an IRF, you must meet several criteria. Your doctor must certify that your condition requires intensive rehabilitation, continued medical supervision, and coordinated care from a multidisciplinary team of doctors and therapists. This intensive therapy typically involves at least three hours of therapy per day, five days a week.
Skilled Nursing Facility (SNF) Coverage
For an SNF, Medicare Part A covers up to 100 days of care per benefit period. The coverage is not unconditional and requires a qualifying hospital stay. This means you must have been admitted as an inpatient to a hospital for at least three consecutive calendar days before your SNF admission. Time spent under observation status does not count toward this requirement.
The cost structure for an SNF per benefit period differs from an IRF:
- Days 1–20: Medicare covers 100% of the approved costs, with no coinsurance for you.
- Days 21–100: You pay a daily coinsurance amount. As of 2025, this coinsurance is $209.50 per day.
- Day 101 and beyond: You are responsible for all costs.
What Ends Coverage Sooner?
It is crucial to note that coverage can end before the 100-day limit if the patient is no longer deemed to need daily skilled care. If a patient's condition stabilizes and they stop showing progress, Medicare may cease payment even if they haven't used all 100 days.
Comparison of IRF and SNF Coverage
| Feature | Inpatient Rehabilitation Facility (IRF) | Skilled Nursing Facility (SNF) |
|---|---|---|
| Maximum Days Covered | 90 days per benefit period (+ 60 lifetime reserve days) | 100 days per benefit period |
| Qualifying Hospital Stay | Not explicitly required for IRF, but common for transfers | Required: At least 3 consecutive inpatient days |
| Cost (Days 1–20) | Full coverage after Part A deductible met | Full coverage ($0 coinsurance) |
| Cost (Days 21–60) | Daily coinsurance | Daily coinsurance |
| Cost (Days 61–90) | Daily coinsurance | Daily coinsurance |
| Cost (Days 91–100) | Higher daily coinsurance (lifetime reserve days) | Daily coinsurance |
| Costs Beyond Limit | You pay all costs | You pay all costs |
| Medical Need | Intensive rehab, doctor supervision, 3+ hours therapy/day | Daily skilled nursing or therapy |
Managing Your Stay and Costs
Staying informed about your coverage is vital. Your hospital discharge planner or the social worker at the rehab facility can provide valuable assistance and clarity on what is covered. It's also important to track your benefit period and to be aware of your inpatient status in the hospital, as observation stays do not count towards SNF eligibility.
If your Medicare coverage for a rehab stay runs out, you have several options. Private long-term care insurance may cover additional days. Supplemental insurance plans, like Medigap, can also help cover coinsurance costs. For those with limited income and resources, Medicaid might provide assistance. Finally, you can choose to pay for the services out-of-pocket.
What Happens When You Need More Care?
If you still need skilled care after your 100 days in an SNF are exhausted, the facility staff can help you explore your options. A new benefit period can be triggered after you have been out of a hospital or SNF for 60 consecutive days and then have another qualifying hospital stay.
For more detailed information and guidance on Medicare coverage, visit the official Medicare.gov website.
Conclusion
Medicare's coverage for rehab hospital stays is not indefinite and is tied to specific rules regarding facility type, medical necessity, and benefit periods. For a Skilled Nursing Facility, coverage lasts up to 100 days per benefit period after a qualifying hospital stay. In an Inpatient Rehabilitation Facility, it covers 90 days per benefit period, with additional lifetime reserve days available. By understanding these limitations and the associated costs, patients and their families can better navigate the complexities of post-hospital rehabilitation.
