Medicare covers inpatient rehabilitation facility (IRF) stays, but only after a hospital stay and only for specific medical conditions

Medicare Part A pays for a rehabilitation facility stay if you meet three conditions: you have been in a hospital for at least three consecutive days, you are admitted to the facility within 30 days of leaving the hospital, and your condition is one Medicare recognizes as needing inpatient rehab. The facility must also be Medicare-certified. You do not choose whether you "may have access to" — your doctor and the facility's medical team determine whether your condition meets Medicare's criteria.

Medicare does not pay for custodial care (help with daily living tasks when no medical treatment is needed) or for facilities that are primarily residential. The distinction matters: a nursing home that provides skilled nursing and therapy may be covered; a facility that mainly helps you bathe and dress will not be.

Key Takeaways

  • Medicare Part A covers inpatient rehabilitation facility care only after a may have access to hospital stay of at least three consecutive days.
  • Your doctor must order the rehab stay, and the facility must be Medicare-certified for the stay to be covered.
  • Medicare covers the full cost of the first 20 days; you pay a daily coinsurance amount (currently $194.50 per day, though this changes yearly) for days 21 through 100.
  • If you need rehab but do not meet the hospital-stay requirement, outpatient therapy or skilled nursing facility care may be options instead.
  • The facility's utilization review team submits your case to Medicare; you will receive a notice explaining what is covered and what you owe.

What conditions Medicare recognizes for inpatient rehab

Medicare covers inpatient rehabilitation for a defined list of conditions. These include stroke, spinal cord injury, traumatic brain injury, amputation, major joint replacement, hip fracture, and severe burns. Conditions like cardiac or pulmonary disease may be covered if they meet specific severity thresholds. Arthritis alone, or a fall with minor fracture, typically does not meet the threshold.

The facility's medical team reviews your medical record to determine whether your condition and your functional status (how much help you need) justify inpatient rehab rather than outpatient therapy or skilled nursing care. This is not a decision you make; it is a clinical information based on Medicare's rules.

How much Medicare pays and what you owe

Medicare Part A covers all approved charges for days 1 through 20 of your inpatient rehabilitation stay. Starting on day 21, you pay a daily coinsurance amount. That amount changes each year; for 2024, it is $194.50 per day. Medicare covers up to 100 days total in a benefit period, though most stays are shorter.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your coinsurance. Check your plan documents or call your plan to learn what your out-of-pocket cost will be. If you have no supplemental coverage, you are responsible for the full coinsurance amount.

The difference between inpatient rehab, skilled nursing, and outpatient therapy

An inpatient rehabilitation facility (IRF) provides intensive therapy — typically three hours or more per day of physical, occupational, or speech therapy — in a hospital-like setting. A skilled nursing facility (SNF) provides nursing care and therapy but usually at lower intensity. Outpatient therapy happens at a clinic or your home and does not require an overnight stay.

Medicare covers all three, but the rules differ. Skilled nursing facility care also requires a three-day hospital stay first, but you pay a daily coinsurance amount starting on day 21 (currently $194.50 per day for 2024). Outpatient therapy is covered under Part B, and you pay 20 percent of the approved amount after you meet your Part B deductible. Your doctor and the facility determine which setting is appropriate for your condition and recovery needs.

How to find a Medicare-certified rehabilitation facility

Your hospital discharge planner or doctor will recommend facilities in your area. You can also search the Medicare Care Compare tool at Medicare.gov, which lists all Medicare-certified inpatient rehabilitation facilities and shows their quality ratings, staffing levels, and infection rates. Call the facility directly to confirm they accept Medicare and to ask about their experience treating your specific condition.

If you are admitted to a facility, the facility's billing department will submit your case to Medicare for review. You will receive a notice (called a "Notice of Utilization Review") explaining what Medicare has approved and what your financial responsibility is. Read this notice carefully and ask questions if anything is unclear.

What happens if Medicare denies coverage

If Medicare determines your condition does not meet the criteria for inpatient rehabilitation, the facility must notify you in writing before discharge. You have the right to appeal. The notice will explain how to request a reconsideration and what information to submit. Many appeals are successful if your medical record shows you need intensive therapy and cannot safely receive it in an outpatient or skilled nursing setting.

If you disagree with the denial, you can also ask your doctor to provide additional documentation of your medical needs. Some facilities have social workers or patient advocates who can help you understand your options and prepare an appeal.

Frequently Asked Questions

Do I need to have been in the hospital for three days before I can go to a rehab facility?

Yes. Medicare requires a three-day inpatient hospital stay before covering an inpatient rehabilitation facility stay. The three days must be consecutive and count toward your hospital deductible. If you were in the hospital for observation only (not admitted as an inpatient), those days do not count.

What if I need rehab but do not meet the three-day hospital requirement?

You may still receive therapy through outpatient physical therapy, occupational therapy, or speech therapy, which Medicare covers under Part B. You can also receive skilled nursing care at home or in a skilled nursing facility if your doctor orders it. Talk to your doctor about which option is safest and most effective for your recovery.

Can I choose which rehabilitation facility I go to?

You can express a preference, and your doctor can recommend a specific facility. However, your insurance coverage and bed availability also affect the choice. If you have a Medicare Advantage plan, check whether the facility is in your plan's network. Your hospital discharge planner can help coordinate the transfer.

Will I have to pay anything out of pocket at a rehabilitation facility?

Yes, starting on day 21 of your stay. You pay a daily coinsurance amount (currently $194.50 per day for 2024, though this changes yearly). If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of this amount. Call your plan to confirm your out-of-pocket cost before admission.

How long can I stay in a rehabilitation facility?

Medicare covers up to 100 days in a benefit period. Most inpatient rehabilitation stays last two to three weeks, depending on your condition and progress. Your doctor and the facility's medical team determine when you are ready for discharge or transfer to a lower level of care.