Medicare covers rehabilitation facility stays, but only after a hospital stay and only for specific conditions

Medicare Part A pays for inpatient rehabilitation facility (IRF) care if you meet three conditions: you spent at least three consecutive days in a hospital, your doctor orders rehabilitation as medically necessary, and you are admitted to the facility within a short window after discharge. Medicare does not cover rehabilitation facilities you choose on your own without a hospital stay first, and it does not cover all types of rehabilitation — only skilled nursing care that helps you regain function after an acute illness or injury.

The facility itself must be Medicare-certified. Your hospital discharge planner can tell you which facilities near you accept Medicare and have an available bed. You do not choose the facility and then ask if Medicare pays; instead, your hospital works with Medicare to place you at a facility that meets the requirements.

Key Takeaways

  • Medicare Part A covers inpatient rehabilitation facility stays only if you were hospitalized for at least three consecutive days when ready before admission.
  • The facility must be Medicare-certified and your doctor must order rehabilitation as medically necessary for your specific condition.
  • Medicare covers the full cost of the first 20 days, then you pay a daily coinsurance amount ($194.50 per day in 2024, though this amount changes yearly) for days 21 through 100.
  • After 100 days in a benefit period, Medicare stops paying and you become responsible for all costs unless you have a supplemental plan.
  • Your hospital's discharge planner coordinates the placement and confirms Medicare coverage before you are transferred.

What conditions may have access to for Medicare-covered rehabilitation

Medicare covers rehabilitation for specific diagnoses that require intensive, skilled therapy. These include stroke, hip fracture, spinal cord injury, traumatic brain injury, amputation, and major surgery complications. The facility must document that you need daily skilled nursing care and therapy that cannot be provided at home or in an outpatient setting.

Your condition alone does not may provide coverage. A patient recovering from hip replacement surgery, for example, may be covered if complications require intensive rehabilitation, but straightforward recovery at home would not may have access to. The hospital's medical team and the rehabilitation facility's admissions staff review your medical records to confirm that your diagnosis and current status meet Medicare's criteria.

If you are admitted to a facility and later Medicare determines your condition does not meet the criteria, you may receive a notice that you are no longer covered. This is rare if your hospital discharge planner did the initial screening correctly, but it can happen if your condition improves faster than expected.

How long Medicare pays and what you pay out of pocket

Medicare Part A covers all approved costs for the first 20 days of your rehabilitation facility stay with no out-of-pocket cost to you. Starting on day 21, you pay a daily coinsurance amount — $194.50 per day in 2024 — for each day through day 100. After day 100 in a single benefit period, Medicare stops paying entirely and you are responsible for all remaining costs.

The coinsurance amount changes each year. Your facility's billing department will tell you the current amount when you are admitted. If you have a Medigap supplemental insurance plan, it may cover some or all of the coinsurance, depending on which plan you have. If you have a Medicare Advantage plan, your out-of-pocket costs may be different; check your plan documents or call the plan directly.

A benefit period runs from the first day you enter a hospital through 60 days after you leave a skilled nursing facility or rehabilitation facility. If you are discharged and then readmitted within that 60-day window, the days count toward the same 100-day limit. If you are readmitted after the 60-day window closes, a new benefit period begins and you get another 100 days of coverage.

The three-day hospital stay requirement

You must be admitted to a hospital as an inpatient for at least three consecutive calendar days before Medicare will pay for a rehabilitation facility. The three days must be full calendar days — the day you are admitted does not count, but the day you are discharged does count. If you are admitted on a Monday and discharged on Thursday, that is three calendar days (Tuesday, Wednesday, Thursday) and you meet the requirement.

Observation status in a hospital does not count toward the three-day requirement, even if you spend three calendar days in the hospital under observation. This is a common source of confusion. If your hospital stay was observation only, Medicare will not cover a rehabilitation facility stay afterward. Your hospital discharge planner will clarify whether you were admitted as an inpatient or placed on observation status.

You must be admitted to the rehabilitation facility within a short time after hospital discharge — typically within a few days. If you go home first and then decide later that you need rehabilitation, Medicare will not cover it. The facility and hospital must coordinate the transfer while you are still hospitalized or when ready after discharge.

How to learn about a facility is Medicare-certified

Your hospital discharge planner will only refer you to Medicare-certified facilities, so you do not need to verify this yourself. However, if you want to check a facility's status, you can search the Medicare Care Compare tool on Medicare.gov. Enter the facility name and your state, and the tool will show whether it is certified and what type of facility it is (inpatient rehabilitation facility, skilled nursing facility, or long-term care hospital).

Inpatient rehabilitation facilities (IRFs) are different from skilled nursing facilities (SNFs), though both can provide rehabilitation. IRFs are more intensive and serve patients with complex medical needs. SNFs provide rehabilitation but also serve patients who need custodial care. Medicare covers both types after a three-day hospital stay, but the coverage rules and daily costs differ slightly. Your discharge planner will recommend the type that matches your medical needs.

What happens if you need rehabilitation but do not meet the requirements

If you do not have a three-day hospital stay, or if your condition does not meet Medicare's criteria, you have other options. You may be able to receive rehabilitation services at home through home health care, which Medicare covers under different rules. You may also receive outpatient rehabilitation at a clinic or hospital outpatient department. Both of these routes require a doctor's order and have their own coverage limits.

If you want to pay out of pocket for a rehabilitation facility stay without Medicare coverage, you can do so. Some facilities accept private pay patients. The cost varies widely by location and facility type, ranging from several hundred to several thousand dollars per day. Ask the facility for a detailed cost estimate before admission.

If you have a Medicare Advantage plan, the coverage rules may differ slightly from Original Medicare. Contact your plan before your hospital discharge to confirm what rehabilitation facilities are in-network and what your costs will be.

Questions to ask your hospital discharge planner

Before you leave the hospital, ask your discharge planner these questions: Does Medicare cover my rehabilitation facility stay, and for how many days? Which facilities are available and in-network for my insurance? What will I pay out of pocket, and does my supplemental or Advantage plan cover any of it? When will I be transferred, and what should I bring with me? Who do I contact if I have questions after I arrive at the facility?

Ask for the name and phone number of the rehabilitation facility's admissions coordinator and your case manager. Ask whether the facility has a social worker who can help you plan for discharge and any care you might need at home afterward. Write down the dates of your hospital stay and the name of your hospital so you have them for reference.

Frequently Asked Questions

What if Medicare denies my rehabilitation facility stay after I am admitted?

You will receive a notice called a Notice of Non-Coverage. You have the right to request a review of the decision. Contact your facility's patient advocate or social worker when ready — they can help you understand the notice and file an appeal if you disagree with the decision.

Can I choose which rehabilitation facility I go to?

Your hospital discharge planner will recommend facilities based on your medical needs, insurance, and bed availability. You can request a specific facility if you have a preference, but the hospital cannot may provide placement. Medicare does not cover facilities you choose independently without a hospital referral.

Does Medicare cover rehabilitation at home instead of a facility?

Yes. Home health rehabilitation is covered under different rules — you do not need a three-day hospital stay, and coverage is based on medical necessity and your ability to be safely cared for at home. Ask your discharge planner whether home health is an option for your situation.

What if I need more than 100 days of rehabilitation?

After 100 days in a benefit period, Medicare stops paying. If you need continued care, you can pay out of pocket, use a supplemental insurance plan if it covers this, or explore other programs. Some facilities offer reduced rates for patients who have exhausted Medicare coverage. Discuss options with your facility's social worker or financial counselor.

Do I have to pay the coinsurance amount if I have a Medigap plan?

It depends on which Medigap plan you have. Plans C, D, G, and M cover the daily coinsurance for days 21 through 100. Other plans may cover part of it or none of it. Check your plan documents or call your insurance company to confirm your coverage before admission.