Does Medicare Cover Inpatient Rehab?

If you or a loved one is considering inpatient rehab, you may be wondering if Medicare will cover the costs. Many people are unaware that Medicare does cover inpatient rehab in certain circumstances, and understanding the eligibility requirements can help you determine if you or your loved one may qualify for coverage. In this article, we will discuss the specifics of Medicare’s coverage for inpatient rehab, so that you can make an informed decision about whether you or your loved one should pursue this form of treatment.

Does Medicare Provide Coverage for Inpatient Rehab?

Inpatient rehab is a form of medical care that provides intensive, specialized treatment for people with physical, mental, and emotional health issues. Medicare is a government-run health insurance program for people 65 and older as well as certain individuals with disabilities. Depending on the circumstances, Medicare may provide coverage for inpatient rehab.

Inpatient rehab typically includes a variety of services such as physical therapy, occupational therapy, speech therapy, and psychological counseling. It may also include medical treatments such as medications, specialized equipment, and other treatments to help individuals become as independent as possible.

Medicare Part A covers inpatient hospital stays, and this may include inpatient rehab. In order for rehab to be covered, it must be ordered by a doctor and done in a Medicare-approved facility. Medicare Part A typically covers up to 100 days of inpatient rehab per benefit period, but this may vary depending on the individual’s situation.

Medicare Part B and Inpatient Rehab Coverage

In addition to Part A, Medicare Part B may also provide coverage for inpatient rehab. Part B covers medically necessary services such as doctor visits, lab tests, and certain medical equipment. Part B may also cover certain types of physical and occupational therapy for inpatient rehab.

In order for Part B to cover inpatient rehab, the patient must be receiving medically necessary services. In addition, the services must be provided by a Medicare-approved provider. Medicare Part B may also cover some of the costs of outpatient rehab if the patient meets certain criteria.

Medicare Advantage and Inpatient Rehab Coverage

Medicare Advantage plans are an alternative to Original Medicare and may provide additional coverage for inpatient rehab. These plans are offered by private companies that contract with Medicare. They typically provide additional benefits such as prescription drug coverage or vision and dental coverage.

Medicare Advantage plans may provide coverage for inpatient rehab, but the coverage may vary from plan to plan. It’s important to check with the plan provider to find out what services are covered and any limitations or restrictions that may apply.

Medicare Supplement and Inpatient Rehab Coverage

Medicare Supplement plans are also an alternative to Original Medicare and may provide additional coverage for inpatient rehab. These plans are offered by private companies and may help cover some of the costs that Original Medicare does not cover.

Medicare Supplement plans may provide coverage for inpatient rehab, but the coverage may vary from plan to plan. It’s important to check with the plan provider to find out what services are covered and any limitations or restrictions that may apply.

Medicaid and Inpatient Rehab Coverage

Medicaid is a government-run health insurance program for people with limited income and resources. Medicaid may provide coverage for inpatient rehab depending on the individual’s situation. It’s important to check with the local Medicaid office to find out what services are covered and any limitations or restrictions that may apply.

Other Insurance and Inpatient Rehab Coverage

In addition to Medicare, Medicaid, Medicare Advantage, and Medicare Supplement plans, some private insurance plans may also provide coverage for inpatient rehab. It’s important to check with the insurance provider to find out what services are covered and any limitations or restrictions that may apply.

Few Frequently Asked Questions

Does Medicare Cover Inpatient Rehab?

A: Yes, Medicare does cover some inpatient rehabilitation services. Medicare Part A covers inpatient rehabilitation services in a hospital or skilled nursing facility (SNF). This includes physical, occupational, and speech-language therapy you need to help you regain your skills and abilities following an illness, injury, or surgery.

What Types of Rehab Does Medicare Cover?

A: Medicare Part A covers inpatient rehabilitation services that are medically necessary to help you regain your skills and abilities following an illness, injury, or surgery. This includes physical therapy, occupational therapy, and speech-language therapy. Medicare also covers some medical social services, medical supplies, and medication used in the rehabilitation process.

How Do I Know if I Qualify for Inpatient Rehab Coverage?

A: To be eligible for Medicare Part A coverage of inpatient rehabilitation services, you must meet the following criteria: You must be admitted to an inpatient rehabilitation facility that is certified by Medicare, you must be under the care of a physician, and you must require intensive rehabilitation therapy services for at least three hours a day, five days a week, for at least two weeks.

What is the Cost for Inpatient Rehab?

A: The cost for inpatient rehabilitation services covered under Medicare Part A depends on the length of your stay, the type of services you receive, and the facility where you receive care. Generally, Medicare Part A covers 80% of the cost of inpatient rehabilitation services, leaving you with a 20% coinsurance.

Are There Any Limits to How Long Medicare Will Cover Inpatient Rehab?

A: Yes, there are limits on the amount of time Medicare will cover inpatient rehabilitation services. Medicare Part A will cover up to 100 days of inpatient rehabilitation services in a benefit period. A benefit period begins the day you are admitted to an inpatient rehabilitation facility and ends when you have been out of the facility for 60 days in a row.

What Other Coverage Options Are Available for Inpatient Rehab?

A: Medicare Part B may cover some inpatient rehabilitation services that are considered medically necessary. Additionally, some Medicare Advantage plans may offer additional coverage for inpatient rehabilitation services. Additionally, you may be able to purchase a supplemental insurance policy to help cover the cost of inpatient rehabilitation services.

In conclusion, the answer to the question of whether Medicare does or does not cover inpatient rehab is dependent upon the individual’s specific circumstances. Medicare generally covers inpatient rehab provided it is deemed medically necessary and provided at an approved facility. However, supplemental insurance may be necessary to cover the associated costs. Ultimately, Medicare beneficiaries should contact their local Medicare office to determine if they are eligible for coverage and if so, what options are available.