Medicare covers rehabilitation multiple times, but the number of visits and the amount it pays depend on the type of rehab, where you receive it, and whether your doctor says it is medically necessary.

Medicare Part A covers inpatient rehabilitation in a hospital or skilled nursing facility after a may have access to hospital stay. There is no set limit on the number of days Medicare will pay for, but you must meet strict medical criteria: you need an acute illness or injury, a doctor's order, and proof that you cannot manage at home. The facility must be Medicare-certified. Your stay ends when your doctor decides you no longer need daily skilled care or when Medicare's medical reviewers determine the care is no longer reasonable and necessary.

Medicare Part B covers outpatient rehabilitation — physical therapy, occupational therapy, and speech-language pathology — through a hospital outpatient department, therapy clinic, or your home. Part B sets an annual dollar limit rather than a visit limit. For 2024, that limit is $2,430 per benefit category (physical therapy and occupational therapy combined count as one category; speech-language pathology is separate). Once you reach the dollar limit, you pay 100% of the cost unless your doctor obtains a special override called an exceptions process.

Key Takeaways

  • Inpatient rehabilitation in a hospital or skilled nursing facility has no visit limit, but you must have been hospitalized first and meet medical necessity criteria.
  • Outpatient rehabilitation under Part B has an annual dollar cap of $2,430 per category, not a visit count, and the cap can be overridden by your doctor's request.
  • Home health rehabilitation is covered under Part A with no visit limit as long as you are homebound and a doctor orders it.
  • Medicare reviews whether rehab remains medically necessary throughout your treatment, and coverage can end if progress slows or goals are met.
  • You pay a copay for each outpatient visit (typically 20% of the approved amount after your deductible), but inpatient stays have different cost-sharing rules.

Inpatient Rehabilitation: Hospital and Skilled Nursing Facility

If you are admitted to a hospital for an acute condition — a stroke, heart attack, major surgery, or serious injury — and your doctor determines you need intensive rehabilitation, Medicare Part A will cover a transfer to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF) with a rehabilitation unit. There is no maximum number of days written into the Medicare rules. Instead, your stay continues as long as your medical team documents that you are receiving skilled care (nursing, therapy, or both) and making progress toward your rehabilitation goals.

The catch is the three-day may have access to stay: you must have been an inpatient in a hospital for at least three consecutive days (not counting the day you leave) within the 30 days before admission to the rehab facility. This rule applies to SNF stays but not always to IRF admissions, though most IRFs require it anyway. If you do not meet this requirement, Medicare will not pay.

Your cost for inpatient rehab depends on the facility type. For a SNF, you pay nothing for the first 20 days, then $194.50 per day (in 2024) for days 21 through 100. After 100 days in a benefit period, you pay all costs. For an IRF, you pay a deductible ($1,632 in 2024) and then a copay per day. Once you have paid the deductible, the copay is one-quarter of the deductible per day.

Outpatient Rehabilitation: The Annual Dollar Limit

Outpatient therapy — whether at a clinic, hospital outpatient department, or your home — is covered under Medicare Part B. The limit is not a number of visits but a dollar amount. For 2024, Medicare will pay up to $2,430 per year for physical therapy and occupational therapy combined, and another $2,430 for speech-language pathology. These limits reset on January 1 each year.

Your therapist's office tracks how much Medicare has paid toward your limit. Once the dollar amount is used, you become responsible for the full cost of each additional visit unless your doctor files an exceptions request (also called a medical review request). Your doctor must document that continued therapy is medically necessary and that you are making progress. Medicare's medical reviewer will decide whether to override the cap. This process takes 10 to 14 business days, and approval is not may provide.

For each outpatient visit, you pay 20% of the Medicare-approved amount after you have met your Part B deductible ($240 in 2024). If your therapist charges more than Medicare's approved amount, you may owe the difference as well, depending on whether they accept Medicare assignment.

Home Health Rehabilitation: No Visit Limit

If you are homebound — meaning you cannot leave home without considerable effort or help — your doctor can order home health rehabilitation. This includes physical therapy, occupational therapy, and speech therapy delivered by a Medicare-certified home health agency. Home health is covered under Medicare Part A, and there is no limit on the number of visits.

You must be homebound and have a doctor's order. The home health agency will send a nurse or therapist to your home, usually one to three times per week. Medicare continues to pay as long as your doctor documents that skilled care is medically necessary and you are making progress. If you improve enough to leave home or if your doctor determines you no longer need skilled care, coverage ends.

You pay nothing out of pocket for home health services covered under Part A, though you may have a copay if Part B services (like therapy) are billed separately. Check with your home health agency about what you will owe.

When Medicare Stops Paying for Rehab

Medicare does not pay indefinitely for any type of rehabilitation. Coverage ends when one of these happens: your doctor says you no longer need skilled care, you reach your rehabilitation goals, your progress plateaus (you stop improving), you become unable to tolerate therapy, or a Medicare medical reviewer determines the care is no longer reasonable and necessary.

Medical reviewers at Medicare's contracted companies (called Quality Improvement Organizations or QIOs) can request records from your facility or therapist at any time to verify that treatment is still medically necessary. If they decide it is not, they will notify you and the provider, usually giving you a few days' notice before coverage ends. You have the right to appeal this decision.

In an inpatient setting, your facility's care team will typically tell you when discharge is planned. In outpatient therapy, your therapist will let you know when you are approaching your annual dollar limit and will discuss whether your doctor should request an exception.

How to Know Your Remaining Coverage

For outpatient therapy, ask your therapist's billing office how much of your annual dollar limit you have used. They can tell you the exact amount Medicare has paid and how much remains. You can also check your Medicare Summary Notice (MSN), which you receive quarterly, or log into Medicare.gov and view your claims under "My Medicare".

For inpatient stays, the facility's financial counselor can tell you how many days you have used and what your remaining coverage is. Ask before you are discharged so you understand what you will owe if your stay extends beyond what Medicare covers.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may help pay some of these costs. Check your plan documents or call your plan's customer service to learn what rehabilitation services are covered and what you pay.

Frequently Asked Questions

Can I get more outpatient therapy visits if I run out of my annual limit?

Yes, if your doctor requests an exceptions process. Your doctor must submit documentation showing that continued therapy is medically necessary and that you are making measurable progress. Medicare's medical reviewer will decide within 10 to 14 business days. Approval is not may provide, but many requests are approved, especially if your condition is complex or your progress is significant.

Does Medicare cover rehabilitation at home after I leave a hospital?

Yes, if your doctor orders it and you are homebound. Home health rehabilitation is covered under Part A with no visit limit. You must have been hospitalized for at least three consecutive days in the 30 days before home health begins. If you do not meet the three-day rule, you may still receive home health, but it will be billed under Part B and subject to the annual dollar limit.

What happens if I improve faster than expected and no longer need rehab?

Your doctor will discharge you from rehabilitation. If you are in an inpatient facility, you will be sent home or to another care setting. If you are in outpatient therapy, your therapist will end your sessions. You will not owe anything for the visits you did not use. If you need rehab again later in the year, you can restart, though outpatient therapy will count toward the same annual dollar limit.

Do I have to pay anything out of pocket for inpatient rehabilitation?

It depends on the facility and how many days you stay. For a skilled nursing facility, you pay nothing for the first 20 days, then $194.50 per day for days 21 through 100. For an inpatient rehabilitation facility, you pay a deductible and then a daily copay. After 100 days in a benefit period, you pay all costs yourself.

Can my Medicare Advantage plan cover more rehabilitation than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but many offer additional benefits. Some plans have higher annual therapy limits or waive the three-day hospital stay requirement for skilled nursing facility admission. Check your plan's summary of coverage or call customer service to learn what rehabilitation benefits your specific plan includes.