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

Medicare Part A pays for a stay at an inpatient rehabilitation facility if you meet three conditions: you spent at least three consecutive days in a hospital (not counting the discharge day), a doctor ordered the transfer to rehab, and your condition is one Medicare recognizes as needing intensive rehabilitation. You do not pay the facility directly — Medicare sends payment to the facility, and you pay a daily coinsurance amount instead of a copay.

The catch is that "rehabilitation facility" means a specific type of place: an inpatient facility where you live while receiving therapy, not an outpatient clinic you visit a few times a week. Medicare also does not cover custodial care — help with daily living when you no longer need medical rehabilitation — even if you are in a facility.

Key Takeaways

  • Medicare Part A covers inpatient rehab only after a hospital stay of at least three days, and only if a doctor orders the transfer.
  • Your condition must be one Medicare recognizes as needing intensive rehabilitation, such as stroke recovery, hip fracture repair, or spinal cord injury.
  • You pay a daily coinsurance amount (currently $194.50 per day in 2024, though this changes yearly) for days 1–20, and the full daily rate for days 21–100.
  • Medicare covers up to 100 days per benefit period, but the facility must discharge you sooner if you stop making progress toward your rehabilitation goals.
  • Outpatient rehabilitation at a clinic or your home is covered under Part B with a copay, but it follows different rules and limits than inpatient care.

Which Medical Conditions may have access to for Inpatient Rehab

Medicare has a specific list of conditions that warrant inpatient rehabilitation. The most common are stroke, hip fracture, knee or hip replacement, spinal cord injury, brain injury, amputation, and severe burns. Your doctor must document that you need intensive, coordinated therapy from multiple specialists — physical therapy, occupational therapy, speech therapy, or others — and that you cannot receive this level of care as an outpatient.

If your condition is not on the list, or if your doctor believes you can make progress with outpatient therapy alone, Medicare will not cover an inpatient stay. In that case, you may be admitted to a skilled nursing facility (SNF) instead, which has different coverage rules, or you may receive outpatient therapy at a clinic or at home.

How Much You Pay Out of Pocket

Your costs depend on how many days you stay. For days 1 through 20, you pay a daily coinsurance amount. For days 21 through 100, you pay the full daily facility rate yourself — Medicare stops paying after day 20. The daily coinsurance and facility rates change each year; in 2024, the coinsurance was $194.50 per day, but you should confirm the current amount with your facility or Medicare before admission.

After 100 days in a benefit period, Medicare coverage ends. A benefit period begins the day you enter the hospital and ends 60 days after you leave the hospital or rehab facility. If you need rehab again after that 60-day window closes, a new benefit period starts and you get another 100 days of coverage.

The Difference Between Inpatient Rehab and Skilled Nursing Facility Care

An inpatient rehabilitation facility (IRF) is designed for people who need intensive therapy and can tolerate three or more hours of therapy per day. A skilled nursing facility (SNF) is for people who need nursing care and some therapy but cannot handle the intensity of an IRF. Both are covered by Medicare Part A after a hospital stay, but the daily costs and length of coverage differ.

At an IRF, you typically receive therapy five to seven days a week. At an SNF, therapy is less frequent and less intensive. If your doctor believes you need the higher level of care, you will be sent to an IRF; if you need mainly nursing support with lighter therapy, you will go to an SNF. The facility type is not your choice — it is determined by your medical needs and your doctor's recommendation.

Outpatient Rehabilitation Under Medicare Part B

If you do not meet the criteria for inpatient rehab, or if you have already used your 100 days, you may still receive outpatient rehabilitation. This includes therapy at a clinic, a hospital outpatient department, or your home. Medicare Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology services.

For outpatient therapy, you pay a copay (usually 20 percent of the Medicare-approved amount after you meet your Part B deductible). There is also an annual limit on how much therapy Medicare will pay for, though your doctor can request an exception if medically necessary. Outpatient therapy does not require a prior hospital stay, so it is an option even if you have never been hospitalized.

What Happens if You Stop Making Progress

Medicare requires that you make measurable progress toward your rehabilitation goals while at an inpatient facility. If your therapy team determines that you have plateaued — that you are no longer improving — Medicare may stop paying, and the facility may discharge you even if you have days remaining in your 100-day benefit.

Before discharge, the facility must notify you and give you a chance to appeal. If you disagree with the decision, you can request a detailed explanation of why progress has stopped and ask for a second opinion. You also have the right to stay at the facility at your own expense if you wish to continue therapy, but Medicare will not pay for those additional days.

How to Find Out What Your Specific Situation Covers

The best way to know what Medicare will cover for your rehab needs is to ask your hospital discharge planner or your doctor before you leave the hospital. They can tell you whether your condition qualifies for inpatient rehab, how many days Medicare is likely to cover, and what your out-of-pocket costs will be. The discharge planner can also help arrange the transfer and make sure all the paperwork is in order.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask about coverage for your specific situation. Have your Medicare card handy and be ready to describe your medical condition and what type of facility you are considering. Medicare representatives can give you general information, though they cannot predict exactly how many days your individual case will be covered.

Frequently Asked Questions

Do I have to go to an inpatient rehab facility, or can I choose outpatient therapy instead?

Your doctor and the hospital discharge team make the recommendation based on your medical needs, not your preference. If your condition requires intensive, coordinated therapy and you can tolerate three or more hours of therapy daily, inpatient rehab is the standard. If you believe outpatient therapy would work for you, discuss it with your doctor before discharge — they may agree, but the decision rests with your medical team.

What if I run out of my 100 days before I am ready to leave?

Once your 100 days are used in a benefit period, Medicare Part A stops paying for inpatient rehab. You can continue at the facility at your own expense, move to outpatient therapy covered by Part B, or go home. Talk to your therapy team about your options and what progress you can realistically make with outpatient care before your inpatient days end.

Does Medicare cover rehab at home instead of at a facility?

Yes, but only as outpatient therapy under Part B, not as inpatient care under Part A. Home health therapy is covered if you are homebound and a doctor orders it, but it is typically less intensive than facility-based therapy. Home therapy is often used after you leave an inpatient facility to continue your recovery.

Will Medicare cover a second stay at a rehab facility if I need it later?

Yes, if a new benefit period has started. A benefit period ends 60 days after you leave the hospital or rehab facility. Once that 60 days passes, a new benefit period begins and you get another 100 days of inpatient rehab coverage, as long as you meet the medical criteria again.

What if my doctor says I do not need inpatient rehab but the hospital wants to send me to one anyway?

This is rare, but if it happens, ask for the reason in writing and request a second opinion from another doctor. You have the right to refuse inpatient admission and choose outpatient therapy instead, though Medicare will only pay for outpatient care if it is medically appropriate. Get the decision in writing so you have a record if there are billing questions later.