Medicare does cover rehabilitation, but only in specific settings and under certain conditions

Medicare pays for rehabilitation services — physical therapy, occupational therapy, and speech therapy — but the coverage depends on where you receive care and whether you meet medical requirements. Medicare will not pay for rehabilitation in your home or at an outpatient clinic unless you are homebound or the therapy follows a hospital stay. The most common way seniors receive covered rehab is in a skilled nursing facility after a hospital admission, or in a hospital's rehabilitation unit.

The type of rehab Medicare covers is medically necessary rehabilitation — therapy ordered by a doctor to help you regain function after an illness, injury, or surgery. This is different from therapy for general wellness or long-term maintenance. You must also have been admitted to a hospital for at least three consecutive days (not counting the day you leave) in the 30 days before entering a skilled nursing facility for Medicare to cover your stay there.

Key Takeaways

  • Medicare Part A covers inpatient rehabilitation in hospitals and skilled nursing facilities if you were hospitalized for at least three days first.
  • Medicare Part B covers outpatient rehabilitation and home health therapy only if your doctor orders it and you meet specific medical requirements.
  • You pay a copay for each therapy visit under Part B, and a daily copay for skilled nursing facility stays under Part A.
  • Medicare limits the number of therapy visits per year, though your doctor can request more visits if medically necessary.
  • Private insurance, Medicaid, or out-of-pocket payment may cover rehabilitation that Medicare does not.

Rehabilitation in a skilled nursing facility after hospitalization

If you spend at least three consecutive days in a hospital, Medicare Part A will cover your stay in a skilled nursing facility for up to 100 days. The facility must be Medicare-certified, and your doctor must order the transfer. You pay nothing for days 1 through 20. From day 21 onward, you pay a daily copay (in 2024, this is $194.50 per day, though this amount changes yearly). After day 100, Medicare stops paying and you are responsible for all costs.

The rehabilitation must be for a condition that requires skilled nursing care — not just information with daily activities. Common reasons Medicare covers skilled nursing facility stays include recovery from hip or knee replacement, stroke, heart attack, or pneumonia. If you are admitted to a skilled nursing facility without a prior hospital stay of three days, Medicare Part A will not cover it, though you may have other coverage options through Medicaid or private insurance.

Rehabilitation in a hospital's inpatient rehabilitation unit

Some hospitals have dedicated inpatient rehabilitation units where you stay as a hospital patient while receiving intensive therapy. Medicare Part A covers these stays if your doctor determines you need at least three hours of therapy per day and can tolerate that level of intensity. You typically stay for two to three weeks. Your copay is the same as for any hospital stay — a deductible for the first day, then nothing for days 2 through 60 in a benefit period.

Inpatient rehabilitation units are used for more serious conditions — major stroke, spinal cord injury, severe burns, or complex orthopedic surgery — where you need round-the-clock medical supervision alongside therapy. Your doctor must refer you directly, and the hospital's rehabilitation team must accept you. Not all hospitals have these units, so availability depends on where you live and which hospitals are in your area.

Outpatient rehabilitation and home health therapy

Medicare Part B covers physical therapy, occupational therapy, and speech therapy in outpatient settings — a therapist's office, a hospital outpatient department, or your home — if your doctor orders it and you meet medical criteria. For home-based therapy, you must be homebound, meaning you cannot leave home without considerable difficulty or the help of another person. For outpatient therapy, there is no homebound requirement.

You pay 20 percent of the Medicare-approved amount for each therapy visit after you meet your Part B deductible. In 2024, the deductible is $240. Medicare also sets an annual limit on how many therapy visits it will cover — currently 60 visits per year for physical therapy and occupational therapy combined, and 60 visits per year for speech therapy. Your doctor can request more visits if medically necessary, and Medicare may approve them, but you should ask your therapist whether they expect to need a request before starting treatment.

What Medicare does not cover

Medicare does not cover rehabilitation for general wellness, fitness, or long-term maintenance — only therapy ordered to treat a specific medical condition. It also does not cover therapy in assisted living facilities, nursing homes that do not provide skilled care, or adult day programs. If you need ongoing therapy after your covered visits end, you will need to pay out of pocket, use private insurance if you have it, or check whether you may have access to for Medicaid in your state.

Medicare also does not cover certain types of therapy that some seniors seek, such as acupuncture for pain management (with limited exceptions), massage therapy, or experimental treatments. If your doctor recommends a therapy that is not on Medicare's covered list, ask whether there is a covered alternative or whether you can appeal the decision.

How to find out what your specific situation covers

Your coverage depends on your exact medical situation, where you receive care, and which Medicare plan you have. If you have Original Medicare (Part A and Part B), the rules above explore. If you have a Medicare Advantage plan, coverage may differ — some plans cover more therapy visits or allow therapy in settings Original Medicare does not. Call your plan's customer service number (on your insurance card) before starting rehabilitation to confirm what is covered.

When you are discharged from a hospital, the hospital's discharge planner should discuss rehabilitation options with you and tell you what Medicare will cover. If you are unsure, ask the planner to explain in writing which facility or setting they are recommending and why Medicare should cover it. Keep that document — it helps if you need to appeal a denial later.

Paying for rehabilitation Medicare does not cover

If you need rehabilitation that Medicare does not cover, you have several options. If you have a Medigap (supplemental insurance) plan, check your policy to see whether it covers any rehabilitation costs. If you have a Medicare Advantage plan, it may cover more visits or different settings than Original Medicare. Some seniors may have access to for Medicaid in addition to Medicare, and Medicaid may cover rehabilitation that Medicare does not.

You can also pay out of pocket. Many rehabilitation facilities offer discounted rates if you pay directly, and some offer payment plans. Before committing to out-of-pocket rehabilitation, ask the facility for a written estimate of total cost and ask whether they offer financial information or sliding-scale fees based on income.

Frequently Asked Questions

Do I have to go to a skilled nursing facility after the hospital, or can I go straight home?

You can choose to go home, but Medicare will not cover rehabilitation services at home unless your doctor orders them and you are homebound. If you go home and later need therapy, you would pay 20 percent of the cost out of pocket (after your deductible) for outpatient visits, or you would need to be homebound for home-based therapy to be covered.

What happens if I run out of therapy visits before I am ready to stop?

Your therapist or doctor can request additional visits from Medicare if they believe more therapy is medically necessary. Medicare reviews these requests and may approve more visits beyond the annual limit. There is no may provide of approval, so ask your therapist early in treatment whether they expect to need a request.

Does Medicare cover therapy for arthritis or chronic pain?

Medicare covers physical therapy for arthritis or chronic pain only if it is ordered by your doctor as treatment for a specific condition — not for general maintenance or wellness. If your doctor orders it, the same rules explore: you pay 20 percent per visit after your deductible, and the annual visit limit applies.

If I have a Medicare Advantage plan, is rehabilitation covered differently?

Medicare Advantage plans must cover at least what Original Medicare covers, but many plans offer more — additional therapy visits, coverage in different settings, or lower copays. Call your plan's customer service number to ask what rehabilitation is covered under your specific plan.

Can I appeal if Medicare denies coverage for rehabilitation?

Yes. If a facility, therapist, or Medicare tells you that rehabilitation is not covered, ask for a written explanation of why. You can file an appeal with Medicare, and you have the right to request a review by an independent reviewer. Ask your doctor or the facility's billing department to help you understand the denial and whether an appeal is likely to succeed.