Medicare Part A (inpatient hospital insurance) and Part B (medical insurance) may both cover certain rehabilitation services in different ways.
Use this helpful guide to learn more about how long Medicare pays for rehab in various types of settings and the costs you may have to pay.
You may have to undergo some rehab in a hospital after a surgery, injury, stroke or other medical event. The rehab may take place in a designated section of a hospital or in a stand-alone rehabilitation facility.
Medicare Part A provides coverage for inpatient care at a hospital, which may include both the initial treatment and any ensuing rehab you receive while still admitted as an inpatient.
Before Medicare Part A begins to pay for your rehab, you must first meet your Part A deductible. In 2019, the Medicare Part A deductible is $1,364 per benefit period.
A benefit period begins the day you are admitted to the hospital. Once you have reached the deductible, Medicare will then cover your stay in full for the first 60 days. You could potentially experience more than one benefit period in a year.
If you continue receiving inpatient care after 60 days, you will be responsible for a coinsurance payment of $341 per day (in 2019) until day 90. Beginning on day 91, you will begin to tap into your “lifetime reserve days,” for which a daily coinsurance of $682 is required in 2019.
You have a total of 60 lifetime reserve days. Once you have exhausted all of your lifetime reserve days, you will be responsible for all hospital costs for any stay longer than 90 days.
When you have been out of the hospital for 60 days in a row, your benefit period ends and your Part A deductible will reset the next time you are admitted.
Your rehab could potentially take place in a skilled nursing facility (SNF). When you enter a skilled nursing facility, your stay (including any rehab services) will typically be covered in full for the first 20 days of each benefit period (after you meet your Medicare Part A deductible).
Days 21 to 100 of your stay will require a coinsurance payment of $170.50 per day in 2019, and you will then be responsible for all costs beginning on day 101.
Certain types of rehabilitation, such as physical therapy, occupational therapy and speech-language pathology, may be administered at an outpatient facility or in the home.
These types of rehab are typically covered by Medicare Part B. After you meet the Medicare Part B deductible (which is $185 per year in 2019), you are typically responsible for paying 20 percent of the Medicare-approved amount for the rehab services.
There is no limit as to how long Medicare Part B will cover these outpatient rehab services, as long as the rehab is considered medically necessary by your primary health care provider.
Medicare can also provide coverage for certain services related to drug or alcohol misuse.
Medicare Part B may cover outpatient treatment services as part of a partial hospitalization program (PHP), if your doctor certifies that you need at least 20 hours of therapeutic services per week. Part B may also cover outpatient substance abuse counseling sessions performed by a doctor, clinical psychologist, nurse practitioner or clinical social worker.
Medicare Advantage (Medicare Part C) and Medicare Part D can each provide coverage for prescription medication related to treatment for drug or alcohol dependency. Coverage will depend on your individual plan.
Medicare Advantage plans are required to provide the same benefits as Original Medicare. Many of these privately sold plans may also offer additional benefits not covered by Original Medicare, such as prescription drug coverage.
This means that a Medicare Advantage plan will pay for your qualified rehab in the same ways that Medicare Part A and Part B would. You could potentially find a Medicare Advantage plan that also offers other benefits that you find helpful but aren’t covered by Original Medicare.
To learn more about Medicare Advantage plans that may be available in your area, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
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