Medicare pays part of the cost for inpatient rehab services if your doctor certifies you need “intensive rehabilitation, continued medical supervision, and coordinated care.”
So, how long does Medicare pay for a rehab facility, and how much will participants be covered for 60 days in rehab?
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After you meet your Part A deductible, Medicare can pay 100% of the cost for your first 60 days in care, followed by a 30-day period in which you are charged a $408 co-payment for each day of treatment in 2024.
Longer stays may count against your lifetime reserve days, after which you may be billed for the full cost of care.
What Is Rehab?
Rehab is a form of inpatient care many seniors receive after a stay in the hospital. If your injury or illness requires close coordination between your doctor and caregivers, you might spend some time getting skilled nursing care to rehabilitate after your initial treatment.
This care may be delivered in a standalone skilled nursing facility (SNF), or you might be transferred to a rehab unit at the hospital where you were initially treated.
People go into rehab for many reasons. At a SNF, staff can monitor your condition and care for you 24 hours a day. Nursing staff may dispense your medication, while facility caregivers help you with personal care needs and other activities of daily living. You may have a doctor on site who can assist with your treatment.
Many people receive physical, occupational and mental health therapy during their time in rehab, as well as prosthetic or orthopedic devices that can help them return to independent living after leaving the facility. Make sure to research the physical therapy guidelines of your Medicare plan.
Medicare Rehab Coverage Services
Because skilled nursing is an inpatient service, most of your coverage comes through the Part A inpatient benefit. This coverage is automatically provided for eligible seniors, usually without a monthly premium.
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If you get benefits through a Medicare Advantage Plans (Part C), your Part A benefits are included in your policy.
Though most people pay no monthly premium for their Part A benefits, you may have to pay the standard inpatient deductible before getting care. In 2024, the Part A deductible $1,632 per benefit period that has to be paid before your Medicare benefits kick in for any inpatient care you get.
Fortunately, Medicare treats your initial hospitalization as part of the same inpatient care experience as the rehab services you get in the same benefit period, so your initial deductible payment can counts toward your inpatient charges in rehab.
Medicare Time Limits
Once you transfer to rehab, Medicare Part A pays 100% of your post-deductible cost for the first 60 days. This pays for all of the inpatient services the SNF provides, though you may also get outpatient services that are billed to Part B.
Be aware that you may have to pay up to 20% of all Part B services, such as transportation and medical office visits, even if they are provided during your inpatient stay at the SNF.
After the first two months, Medicare rehab coverage continues but is limited pay but is limited during your stay. From days 61 to 90, you may be charged a co-payment amount of $408 a day in 2024. After your inpatient benefits are exhausted, you may have to pay all continuing costs out of pocket.
Medicare Supplement Insurance
So, what can you do when coverage runs out for rehab? Many participants have a Medicare Supplement Insurance (also called Medigap) policy, which can help with the uncovered costs of inpatient rehab care.
A Medicare Supplement plan can pick up some or all of the Part A deductible you would otherwise be charged, assist with some Part B expenses that apply to your treatment and potentially cover some additional out-of-pocket costs.
Coverage details vary from one Medicare Supplement Insurance policy to another, so it’s a good idea to check with a representative from your insurance carrier before you transfer to a rehab facility.
Medicaid and Rehabilitation Coverage
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Medicaid is a joint federal-state health insurance program that helps millions of people with limited means to pay for healthcare, which can include the costs of rehab that Medicare doesn’t cover.
If you are dual-eligible for both Medicare and Medicaid, your rehab services will probably be billed first to Medicare, with any remaining costs transferred to Medicaid. You may still have to meet a deductible or share of cost before your Medicaid benefits can kick in, but these benefits will likely continue for as long as your rehab is deemed medically necessary.
How Long Will Medicare Pay for a Rehab Facility?
Medicare will pay for a rehab facility for up to 90 days per benefit period. If you recover sufficiently to go home, but you need rehab again in the next benefit period, the clock starts over again and your services are billed in the same way they were the first time you went into rehab.
What happens when Medicare runs out for Rehab?
If your stay in rehab is continuous, and it runs over the allotted 90 days, Medicare may continue to assist with the cost by dipping into your lifetime reserve days. You may be billed up to $816 for each lifetime reserve day spent in rehab in 2024.
When you sign up for Medicare, you are given a maximum of 60 lifetime reserve days. You can apply these to days you spend in rehab over the 90-day limit per benefit period. These days are effectively a limited extension of your Part A benefits you can use if you need them, though they cannot be renewed and once used, they are permanently gone.
FAQ
What rehab services does Medicare Part A cover?
Medicare’s inpatient care benefit pays for the room and board you get during an inpatient stay in rehab, along with any inpatient medical procedures and treatments. You may not have Part A coverage for outpatient services, though, which are typically paid for under Part B. If you get coverage through a Part C Medicare Advantage plan, both types of care are automatically included under the same policy.
Can I use Medicare coverage for voluntary admissions to rehab?
In order to qualify for Part A coverage for rehab services, you must have a doctor’s recommendation for the admission. Medicare helps pay for medically necessary stays in rehab, and you may not be covered for elective care.
Where can I get help planning for a stay in rehab?
You can speak with a Medicare worker about coverage limits while you’re in rehab. Your doctor, a plan representative from your supplemental provider and the care planner at your rehab facility might also have information you need.
You can also plan your coverage with a certified Medicare benefits counselor or senior financial planner. These professionals can give you up-to-date information and help you plan your coverage for rehab.
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