What Medicare covers for rehabilitation stays

Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), but you pay nothing for days 1–20, and a daily copay for days 21–100. The catch: you must have been admitted to a hospital for at least three consecutive days first, and a doctor must order the rehab as medically necessary within 30 days of hospital discharge.

Not all rehabilitation is covered the same way. Home health services, outpatient therapy, and long-term care facilities follow different rules and different payment structures. The type of facility and the reason you need rehab both affect what Medicare will pay.

Your actual coverage depends on whether you have used any of your 100 days in the current benefit period, whether your condition meets Medicare's definition of "skilled care," and whether the facility is Medicare-certified. A benefit period starts the day you enter the hospital and ends 60 days after you leave the facility without being readmitted.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing or rehabilitation facility per benefit period, with no cost for days 1–20 and a daily copay of $194.50 (in 2024) for days 21–100.
  • You must have a hospital stay of at least three consecutive days before Medicare will cover any facility-based rehab, and the rehab must start within 30 days of discharge.
  • Home health therapy and outpatient therapy are covered under different rules and may not count against your 100-day limit.
  • If you need rehab after your 100 days end, you pay the full cost unless you have a Medigap or Medicare Advantage plan that covers additional days.
  • The facility must be Medicare-certified and your doctor must document that skilled nursing or therapy is medically necessary for your condition.

The three-day hospital stay requirement

Before Medicare will pay for any inpatient rehab, you must first spend at least three consecutive days in a hospital. Observation stays do not count—only days when you are formally admitted as an inpatient. This is one of the most common reasons people discover their rehab is not covered: they spent two days in observation and one day admitted, or they were in the emergency department but never formally admitted.

The three days must be consecutive, meaning you cannot count a day you left and came back. If you are discharged and readmitted, the clock restarts. Once you meet the three-day requirement, you have 30 days from the date you leave the hospital to begin rehab at a facility. If you wait longer than 30 days, Medicare will not cover it unless you are readmitted to the hospital first.

Daily costs and what you pay out of pocket

For days 1 through 20 in a skilled nursing or rehabilitation facility, Medicare Part A pays 100 percent of the cost. You pay nothing during this period, though you may still owe your Part A deductible if you have not met it yet in the current benefit period.

Starting on day 21, you pay a daily copay. In 2024, this copay is $194.50 per day. You are responsible for this amount for each day you stay from day 21 through day 100. After day 100, Medicare stops paying entirely, and you owe the full cost of the facility unless you have additional coverage through a Medigap plan or Medicare Advantage plan.

If you have a Medigap plan (also called Medigap insurance), some plans cover part or all of the daily copay for days 21–100. If you have a Medicare Advantage plan, coverage varies by plan—some cover additional days beyond 100, and some do not. Check your plan documents or call your plan to find out what you owe.

Skilled nursing facilities versus rehabilitation facilities

Medicare treats skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) the same way for payment purposes—both are covered under Part A for up to 100 days per benefit period. The difference is in what they do and who they serve.

A skilled nursing facility provides nursing care, medication management, and therapy (physical, occupational, or speech) for people recovering from surgery, illness, or injury. An inpatient rehabilitation facility is more intensive and serves people who need several hours of therapy per day—typically those recovering from stroke, spinal cord injury, or major surgery. Your doctor decides which type of facility is appropriate based on your medical needs.

Both must be Medicare-certified for Medicare to pay. If you go to a facility that is not certified, Medicare will not cover any of the cost. Before you are admitted, ask the facility whether it is Medicare-certified and whether it accepts Medicare.

Home health and outpatient therapy coverage

If you need therapy but do not need to stay overnight in a facility, Medicare Part A and Part B may cover home health services or outpatient therapy instead. These do not count against your 100-day limit.

Home health services are covered if a doctor orders them, you are homebound (meaning you cannot leave home without help), and the services are medically necessary. A home health agency sends nurses, therapists, or aides to your home. Medicare Part A covers the services with no copay, though you still pay your Part A deductible if you have not met it.

Outpatient therapy—physical therapy, occupational therapy, or speech therapy at a clinic or hospital—is covered under Part B. You pay 20 percent of the cost after you meet your Part B deductible. There is no day limit on outpatient therapy, but Medicare reviews the medical necessity of continued treatment.

What happens when your 100 days run out

If you need more than 100 days of facility-based rehab in a benefit period, Medicare stops paying after day 100. You then owe the full daily cost of the facility. This can be thousands of dollars per day.

If you have a Medigap plan, some plans (Plan C, D, F, G, M, and N) cover some or all of the cost after day 100. If you have a Medicare Advantage plan, check your plan documents—some plans cover additional days, and some do not. If you have neither, you will need to pay out of pocket, move to a less expensive facility, or discuss other options with your social worker or discharge planner.

A new benefit period begins 60 days after you leave a facility without being readmitted to the hospital. If you are readmitted to the hospital and then return to a facility, you start a new benefit period with a fresh 100 days. This is why some people are readmitted to the hospital strategically—to reset their benefit period—though this should only happen if medically necessary.

Questions to ask your doctor and facility

Before you are discharged from the hospital to a rehab facility, ask your doctor or discharge planner these questions: Is the facility Medicare-certified? Does my condition meet Medicare's definition of skilled care? How many days of rehab does my doctor think I will need? What will I owe out of pocket? Does my insurance cover days beyond 100?

Ask the facility: What is your daily rate? Will you bill Medicare directly? What happens on day 101 if I am still here? Do you accept my insurance plan? Can you provide an estimate of my out-of-pocket costs?

If you are unsure whether you meet the three-day hospital stay requirement, ask the hospital to confirm in writing that you were admitted as an inpatient for three consecutive days. This document protects you if there is a dispute later about whether Medicare should pay.

Frequently Asked Questions

Does observation time in the hospital count toward the three-day requirement?

No. Only days when you are formally admitted as an inpatient count. Observation stays, even if they last 24 or 48 hours, do not count. Ask the hospital to confirm in writing whether you were admitted as an inpatient or held for observation.

Can I use my 100 days across multiple facilities?

Yes. If you spend 30 days in one facility and then move to another, the second facility counts against your remaining 70 days in that benefit period. The 100 days total applies across all skilled nursing and rehabilitation facilities combined.

What if my doctor says I need more than 100 days but Medicare denies coverage?

You have the right to appeal. Ask the facility for a detailed explanation of the denial. You can request a peer-to-peer review, where your doctor speaks directly with a Medicare medical reviewer. If you disagree with the outcome, you can file a formal appeal. A social worker or patient advocate at the facility can help you through this process.

Does Medicare Advantage cover rehab the same way as Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but they may cover more. Some plans cover additional days beyond 100, and some have different copays. Check your plan documents or call your plan to find out your specific coverage.

If I go home and then need rehab again, do I get another 100 days?

Only if you start a new benefit period. A new benefit period begins 60 days after you leave a facility without being readmitted to the hospital. If you are readmitted to the hospital within 60 days, you are still in the same benefit period and your 100 days do not reset.