Inpatient rehabilitation can help a person who is recovering from illness, injury, or serious surgery and requires an intensive therapy program. It also provides coordinated care doctors and therapists prescribe, as well as physician supervision.
An individual’s doctor must certify that they have a condition that requires continued medical supervision, intensive rehab, and coordinated care for Medicare to cover inpatient rehabilitation.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
For each benefit period, Medicare Part A covers up to 90 days of inpatient care. This can include time spent in a hospital, as well as time in an inpatient rehab facility.
A benefit period begins when a person is admitted to a hospital and ends when they have not received any inpatient care for 60 days. If they are admitted again after a benefit period ends, then a new benefit period begins.
After 90 days, a person can use their reserve days and continue to receive Medicare coverage. Reserve days are additional days of inpatient coverage. Each person is given 60 reserve days in their lifetime.
During a person’s time in an inpatient rehab facility, Medicare covers:
- all rehabilitation services, including:
- physical therapy
- occupational therapy
- speech therapy
- meals
- nursing care
- a semiprivate room
- prescription drugs
- other hospital services and supplies
For each inpatient benefit period, an individual is responsible for paying the following amounts:
- Days 1 to 60: $1,676 deductible
- Days 61 to 90: $419 per day
- Days 91 and beyond: $838 per day while using lifetime reserve days
- After day 150: All costs
A note on deductibles
An individual does not have to pay a deductible for inpatient rehabilitation if Medicare already charged them a deductible for care they received in a hospital within the same benefit period.
This is because the benefit period begins on the first day of a hospital stay, and that stay counts toward the deductible.
This means a person will not pay a deductible for inpatient rehabilitation if they are:
- transferred to an inpatient rehab facility directly from the hospital.
- admitted to an inpatient rehab facility within 60 days of being discharged from a hospital.
