Medicare and Rehab

Rehabilitation services are offered by specialty hospitals or hospitals in general that offer inpatient rehabilitation care. Rehab is also available as an outpatient service through skilled nursing and dedicated rehabilitation facilities.

Inpatient rehabilitation can be required for patients recovering from surgery or a serious injury. These patients require a high level of specialized care that is unavailable in an ordinary treatment or outpatient facility.

People suffering from medical conditions such as spinal cord injury, stroke, brain injury or any major trauma does not only require intensive treatments but also prolonged rehabilitation services. Those who have undergone hip or knee replacement are also eligible for rehabilitation services.

Will Medicare help pay for rehabilitation services?

Yes, Medicare covers rehab. Medicare Part A generally covers all patient care at the hospital. This coverage includes both initial treatment and patient recovery services such as rehab during inpatient stay. Medicare Part B on the other hand covers certain types of rehabilitation including occupational therapy, speech treatment, and physical therapy. These rehabilitation services can be administered at outpatient facilities or at the patient’s home.

Services offered by rehabilitation facilities include:

Physical therapy
Occupational therapy
Speech therapy
Rehabilitation nursing
Orthotic and prosthetic services
Psychological assistance

Medicare also covers drug or alcohol misuse services. These can be covered under Medicare Part B. Outpatient services in rehabilitation facilities or an inpatient stay. Part B can cover outpatient substance counselling sessions if performed by a doctor or qualified medical professional.

What is an Inpatient Rehabilitation Facility?

An inpatient rehabilitation facility or an acute care rehabilitation center can be a separate facility within a hospital a standalone facility. These facilities provide specialized care for physical therapy or occupational therapy. IRFs are supervised by a doctor and operates as a full-time skilled nursing facility.

How much doe Medicare Cover?

Beneficiaries must first make the Part A deductible per benefit period payments before benefits kick in. People receiving inpatient care after 60 days are required to make a daily coinsurance payment until day 90. However, on day 91, the “lifetime reserve days” apply which require higher daily coinsurance payments.

People are entitled to a total of 60 lifetime reserve days and once this is exhausted, all payments for hospital stays longer than 90 days are shouldered by the patient. The benefit period ends when the patient has been out of the hospital for 60 days in a row. Part A deductibles reset when the patient is readmitted.

Rehabilitation services are mostly covered under Medicare Part B. To avail of its benefits, patients must first meet the yearly deductible. Patients are generally responsible for paying 20 percent of rehabilitation services. There are no set limits on how long Medicare Part B will cover rehabilitation services. The only requirement is that these rehabilitation services are considered medically necessary by your doctor or health provider.

Patients who are qualified to receive Medicare covered care in a rehabilitation facility will have the same out-of-pocket costs for those receiving inpatient hospital stay. Those who do not qualify for a Medicare covered stay in an inpatient rehabilitation facility can still qualify for rehabilitation in a skilled nursing facility or in another Medicare approved outpatient facility.