How Many Days Does Medicare Cover in a Rehab Facility?

Medicare Part A covers inpatient rehabilitation care in a skilled nursing facility (SNF) for a limited time, provided specific conditions are met. Medicare can cover up to 100 days in a SNF per benefit period, but with varying levels of cost-sharing.

In this guide, you'll learn:

The conditions for Medicare coverage of rehab in a SNF.
The cost-sharing structure for different days of coverage.
What constitutes a "benefit period" in Medicare.
How to ensure you meet the eligibility criteria.

Medicare Coverage in a Rehab Facility (SNF)

Eligibility Requirements

Coverage Duration and Cost-Sharing

Benefit Period

Ensuring Eligibility

Conclusion

How Many Days Does Medicare Cover in a Rehab Facility FAQs

How many days does Medicare allow for rehab?

What is the maximum number of days of inpatient care that Medicare will pay for?

Does Medicare pay for rehab at home for seniors?

What is the 30 day rule for Medicare?

Medicare Coverage in a Rehab Facility (SNF)

Medicare's coverage of rehabilitation in a SNF is subject to several conditions:

Eligibility Requirements

Qualifying Hospital Stay: You must have had a qualifying hospital stay of at least three consecutive days.
Doctor's Order: Your doctor must order inpatient rehabilitation care.
Medical Necessity: You must require skilled nursing or rehabilitation services on a daily basis.
Improvement Potential: Your condition must show potential for improvement through rehabilitation.

Coverage Duration and Cost-Sharing

Days 1-20: Medicare covers 100% of the costs.
Days 21-100: You'll have a daily coinsurance amount.
Days 101 and Beyond: Medicare does not cover SNF rehabilitation.

Benefit Period

A benefit period begins when you're admitted to a hospital or SNF and ends when you've been out for 60 consecutive days.
A new benefit period means a new set of 100 days of coverage, provided you meet the eligibility criteria.

Ensuring Eligibility

To ensure you meet the eligibility criteria:

Doctor's Documentation: Ensure your doctor thoroughly documents your medical need for rehabilitation.
Qualifying Hospital Stay: Confirm your hospital stay meets the three-day requirement.
Medical Records: Keep records of your medical documentation and SNF invoices.
Understand Benefit Periods: Understand how benefit periods work to maximize your coverage.

Conclusion

Medicare provides valuable coverage for rehabilitation in SNFs, but it's essential to understand the limitations and eligibility requirements. Understanding benefit periods is also very important. For more insight into how this concept interacts with others, see our detailed guide on Medicare Part A, which further explores the overall structure of Medicare's hospital insurance and its implications in greater depth.