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After undergoing knee replacement surgery, the patient may need to go to rehabilitation for further treatment. One of the places where this rehab can take place is in a skilled nursing facility. Medicare Part A provides coverage for skilled nursing facilities. However, are you eligible for Medicare Part A’s coverage for inpatient rehabilitation after knee surgery?
Or, put another way, “does Medicare cover rehab After knee surgery?” In this article, we answer that question in clear, plain English. You will also find information about the average costs of inpatient rehabilitation and more.
Does Medicare Cover Rehab After Knee Surgery?
The short answer is yes. Medicare will cover the cost of your rehab after knee surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your inpatient rehabilitation. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for rehab after knee surgery. Coverage for inpatient rehabilitation after knee surgery is provided by Medicare Part A. Medicare Part A provides coverage for rehabilitation in a skilled nursing facility after surgery or an injury.
However, for Medicare Part A to provide coverage for inpatient rehabilitation after knee surgery, the patient needs to be first admitted to a hospital for at least three days.
Medicare Part A provides coverage for inpatient rehab in a skilled nursing facility for up to 100 days. Medicare Part A will cover 100 percent of the costs of rehab after your knee surgery from days 1 to 20. From days 21 to 100, Medicare Part A will still provide coverage for your inpatient rehabilitation after your knee surgery, however, you will pay a copayment of $185 per day.
After 100 days in a skilled nursing facility, Medicare Part A will no longer provide coverage for your inpatient rehabilitation.
On the other hand, Medicare Part B provides coverage for rehabilitation after knee surgery if it takes place in an outpatient rehabilitation facility. Medicare Part B will cover 80 percent of the costs of outpatient rehabilitation after knee surgery. You will pay for the remaining 20 percent.
Other than rehabilitation in an outpatient setting, Medicare Part B also provides coverage for doctor’s visits after the surgery as well as durable medical equipment, or DME.
Part C Coverage for Rehab After Knee Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for rehabilitation after knee surgery. Part C plans are required to cover all the same treatments, procedures and services that Parts A & B cover. But Part C plans will also include coverage for things that Parts A & B do not. Exactly what those things are and how much they cost depend on the Part C plan you have.
How Much Does Rehabilitation After Knee Surgery Cost?
Physical therapy rehabilitation may cost somewhere from $50 to $350 or even more per session. This cost varies depending on the provider.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover MRI of shoulders?