Medicare and Rehabilitation Care

Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive inpatient rehabilitation therapy. This kind of care is intended for patients recovering from a serious illness, surgery, or injury and requires a high level of specialized care that generally cannot be provided in another setting.

Common conditions which may qualify for care in a rehabilitation hospital include ;

• stroke
• spinal cord injury
• brain injury. 

Hip or knee replacement is not covered by Medicare, especially if you have no other complicating condition.

Medicare-covered services offered by rehabilitation hospitals include:

• Medical care and rehabilitation nursing
• Physical, occupational, and speech therapy
• Social worker assistance
• Psychological services
• Orthotic and prosthetic services

To qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary, meaning you must require all of the following services to ensure safe and effective treatment:

• 24-hour access to a doctor which means you require frequent, direct doctor involvement, at least every 2-3 days
• 24-hour access to a registered nurse with specialized training or experience in rehabilitation
• Intensive therapy, which generally means at least three hours of therapy per day. You may still qualify if you are not healthy enough to withstand three hours of therapy per day)
• And, a coordinated team of providers including, at minimum, a doctor, a rehabilitation nurse, and one therapist

Your doctor must also expect that your condition will improve. That after a rehabilitation hospital stay, you will be able to function more independently.  Such as, therapy may help you regain the ability to eat, bathe, and dress on your own, live at home, and/or live with family rather than in a living facility.

If you qualify for Medicare-covered care in a rehabilitation hospital, your out-of-pocket costs will be the same as for any other inpatient hospital stay. 

Also keep in mind that if you enter a rehabilitation hospital after being an inpatient at a different facility, you will still be in the same benefit period. If you do not qualify for a Medicare-covered stay in an inpatient rehabilitation hospital, you may still qualify for rehabilitation care from a skilled nursing facility, a home health agency, or in an outpatient setting.