What Medicare Covers After a Hospital Rehab Stay

Leaving a hospital rehabilitation stay, often called inpatient rehabilitation facility (IRF) care, is a significant milestone in recovery. However, the transition back home can be filled with uncertainty, especially regarding ongoing care and its costs. Understanding what Medicare covers after a hospital rehab stay is crucial for ensuring a seamless continuation of therapy and support, preventing setbacks, and avoiding unexpected medical bills. This coverage is not automatic or unlimited, it follows specific rules and benefit periods. Navigating these rules effectively can mean the difference between a successful recovery at home and an unnecessary return to the hospital.

Understanding Your Medicare Coverage After Rehab

Original Medicare (Part A and Part B) provides a structured framework for post-rehab care, but it is not a blank check. Coverage is designed to support medically necessary services that help you maintain or improve your functional abilities. The type of care you receive after discharge depends heavily on your clinical needs, your doctor’s orders, and the specific Medicare benefits you qualify for. It is essential to differentiate between the types of care settings, as each has its own coverage rules, cost-sharing requirements, and eligibility criteria. Misunderstanding these can lead to gaps in care or significant out-of-pocket expenses.

The Role of Skilled Nursing Facility (SNF) Care

For many patients, the next step after an inpatient rehab stay is further care at a Medicare-certified Skilled Nursing Facility (SNF). This is not custodial long-term care, but a continuation of skilled nursing and therapy services. Crucially, Medicare Part A covers SNF care only if you meet a strict set of conditions. First, you must have had a qualifying hospital stay of at least three consecutive days (not counting the day of discharge). Second, you must be admitted to the SNF within 30 days of leaving the hospital. Third, your doctor must certify that you need daily skilled care (like physical therapy or intravenous injections) that can only be provided in a SNF.

If you meet these requirements, Medicare Part A covers your SNF stay in full for the first 20 days. For days 21 through 100, you are responsible for a daily coinsurance amount. In 2024, this coinsurance is $204.00 per day. After day 100, you pay all costs. It is vital to note that this benefit period is tied to your hospital stay. A new benefit period, with a new set of 100 SNF days, begins only after you have been out of a hospital or SNF for 60 consecutive days. Understanding these timelines is key to planning your recovery and finances.

Coverage for Home Health Care and Outpatient Therapy

If you are well enough to return home but still require professional care, Medicare may cover home health services under Part A and/or Part B. To qualify, you must be considered “homebound,” meaning leaving home requires a considerable and taxing effort. Your doctor must also establish a plan of care that includes intermittent skilled nursing care, physical therapy, or speech-language pathology. Occupational therapy may also be covered. Medicare-certified home health agencies provide these services.

Medicare covers eligible home health services at 100% for the cost of the care itself. You pay nothing for the skilled nursing or therapy. However, you may pay 20% of the Medicare-approved amount for durable medical equipment (DME), such as a wheelchair or walker, provided by the agency. This is where understanding your overall Medicare costs becomes important, as planning for such expenses is part of a sound financial strategy, similar to preparing for annual premium changes discussed in our resource on how Medicare costs can increase each year.

For ongoing rehabilitation needs that do not require a home health nurse, Medicare Part B covers outpatient physical, occupational, and speech therapy. You can receive these services at a doctor’s office, a hospital outpatient department, or a standalone therapy clinic. Under Part B, you typically pay 20% of the Medicare-approved amount for each therapy service after meeting your Part B deductible. Importantly, Medicare no longer has a specific dollar cap on therapy benefits, but therapists must document that your care is medically necessary and that you are making measurable progress.

Durable Medical Equipment and Prescription Drugs

Recovery at home often requires tools to aid mobility and safety. Medicare Part B covers Durable Medical Equipment (DME) that serves a medical purpose, can withstand repeated use, and is appropriate for use in the home. Common examples post-rehab include walkers, hospital beds, patient lifts, and commodes. Coverage requires a doctor’s prescription stating the equipment is medically necessary. Medicare typically pays 80% of the approved amount after your Part B deductible, and you pay the remaining 20%. You must use a Medicare-enrolled supplier for the equipment to be covered.

Managing medications is another critical component of post-rehab care. Original Medicare (Part A and B) does not cover most prescription drugs you take at home. This coverage is provided through a standalone Part D prescription drug plan or a Medicare Advantage plan (Part C) that includes drug coverage. It is imperative to ensure your medication list is reviewed and that your Part D plan covers your specific drugs. For specialized medications, such as those used for weight management in certain chronic conditions, you may need to verify specific coverage, as detailed in our article exploring Medicare coverage for Wegovy and similar drugs.

What Medicare Does Not Cover After Rehab

Understanding the limits of Medicare is just as important as knowing what is covered. There are significant gaps that can create financial and care challenges for recovering individuals.

• Custodial or Long-Term Care: Medicare does not pay for non-medical, custodial care if that is the only care you need. This includes help with activities of daily living (ADLs) like bathing, dressing, eating, and using the bathroom, if you do not also require skilled nursing or therapy services.
• 24-Hour Care at Home: Home health care is intermittent and part-time. Medicare does not cover round-the-clock care or homemaker services like shopping and cleaning.
• Most Dental, Vision, and Hearing: Routine dental care, eyeglasses, and hearing aids are generally not covered by Original Medicare. This can be a significant gap, as hearing loss can impact recovery and safety. For options, you can review information on affordable solutions for hearing aids and Medicare.
• Meals Delivered to Your Home: While some Medicare Advantage plans may offer meal delivery benefits, Original Medicare does not cover this service.

For services not covered by Medicare, you may need to pay out-of-pocket, use long-term care insurance if you have it, or seek assistance from state Medicaid programs or community-based organizations if you qualify based on income and assets.

The Role of Medicare Advantage Plans

Many beneficiaries receive their Medicare benefits through a Medicare Advantage (Part C) plan offered by a private insurer. These plans must cover everything that Original Medicare covers (Part A and Part B), but they often include additional benefits like routine vision, dental, hearing, and even fitness memberships or transportation to medical appointments. Some plans may also offer limited coverage for non-skilled in-home support services.

However, these plans operate within provider networks and require prior authorization for many services. Your coverage for post-rehab care, including SNF stays, home health, and therapy, will follow the plan’s specific rules. You must use in-network providers and facilities unless in an emergency. It is critical to contact your plan before discharge to understand your coverage, get necessary authorizations, and identify in-network providers for continued therapy or home health. This proactive step can prevent denied claims and high costs.

Planning Your Discharge and Advocating for Coverage

A successful transition from rehab hinges on careful discharge planning. The hospital or rehab facility is required to provide a discharge plan. You and your family should be active participants in this process. Ask detailed questions about the recommended next level of care, the reasons for it, and how it will be covered. Request a written plan that includes follow-up appointments, medication lists, and therapy schedules.

If you receive a notice that Medicare is denying coverage for a recommended service (like a “Notice of Non-Coverage” for a SNF stay), you have the right to appeal. The first step is usually a fast-track appeal. Do not hesitate to use this right if you believe the care is medically necessary. Your doctor can provide supporting documentation. For complex situations involving expensive medications, knowing your appeal rights is also valuable, as outlined in our guide on Medicare coverage options for Ozempic and similar drugs.

Frequently Asked Questions

How long will Medicare pay for my outpatient therapy after rehab?
Medicare Part B covers outpatient therapy as long as it is deemed medically necessary and you show progress. There is no longer a hard financial cap, but therapists must justify the need for continued care through regular assessments and documentation.

Does Medicare cover transportation to my outpatient therapy appointments?
Original Medicare does not cover non-emergency medical transportation. However, some Medicare Advantage plans may offer this as a supplemental benefit. You should check with your plan directly.

What if I need help at home but don’t qualify for Medicare home health?
If you only need help with personal care (bathing, dressing) and not skilled care, you will likely need to pay out-of-pocket, use long-term care insurance, or explore eligibility for Medicaid or state-funded programs for low-income seniors.

Can I choose any home health agency or SNF?
For Original Medicare, you can choose any agency or facility that is certified by Medicare and accepting patients. For Medicare Advantage, you typically must use providers within your plan’s network to receive full coverage.

What happens if my rehab needs exceed 100 days in a SNF?
After day 100 in a benefit period, you are responsible for all costs. You may need to use personal savings, long-term care insurance, or apply for Medicaid if you meet the financial and clinical criteria for nursing home coverage under your state’s program.

Navigating post-rehab care under Medicare requires a clear understanding of benefit periods, coverage criteria, and cost-sharing. By actively participating in discharge planning, verifying coverage with your plan (whether Original Medicare or Medicare Advantage), and knowing what services are and are not covered, you can create a strong foundation for continued recovery. This knowledge empowers you to focus on your health while managing the practical and financial aspects of care, ultimately supporting the best possible outcome after a hospital rehabilitation stay.