When we are talking about rehabilitation, many things come into our minds. Such as substance abuse rehabilitation, physical rehabilitation, occupational therapy, and many others. Nevertheless, most of them, if not all, are for restoring our health, be it physical or mental.
A common question many people have is, “does Medicare cover Rehab?” In this article, we answer the question in clear, plain English. You will also find the average costs of rehab, as well as other helpful info.
Does Medicare Cover Rehab?
The short answer is yes; Medicare will cover the cost of rehab. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your rehab. 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. Medicare Parts A and B cover certain rehab services in different ways.
Medicare Part A Coverage for Rehab
Medicare Part A and will provide coverage for rehab costs if it is done in a hospital or an inpatient setting. However, you must pay your Part A deductible which in 2021 is $1,484 per benefit period.
Medicare Part A covers 100 days of rehab in a skilled nursing facility. It will cover the first 20 days in full. Then, starting from the 21st day to the 100th day, you will pay a coinsurance of $185.50. If you stay at a skilled nursing facility beyond the 100th day, you will shoulder all of the costs.
On the other hand, when talking about hospital stays, Medicare Part A covers 90 days of inpatient hospital rehab.
From the 1st day to the 60th day, Medicare Part A will cover all the expenses in full. From the 61st day to the 90th day, you will pay a coinsurance of $371.
If you go beyond the 90th day, you will begin to tap into your “lifetime reserve days” which requires a daily coinsurance of $742 in 2021.
Your benefit period will end and your Part A deductible will reset if you are out of the hospital for 60 days. Medicare Part A covers inpatient care at a hospital, which includes both treatment and follow-up rehab afterward.
Certain types of rehabilitation are best done in outpatient facilities or your home. Such therapies may include occupational therapy and physical therapy. Medicare Part B provides coverage for outpatient rehabilitation.
Unlike Medicare Part A, Part B does not have limits on how long they will cover your rehabilitation, as long as it is considered necessary by your healthcare provider.
Part B Coverage for Rehab
Medicare Part B may also provide coverage for substance abuse rehab as part of a partial hospitalization program (PHP). However, your healthcare provider must order that you need at least 20 hours of therapeutic services per week.
Medicare Advantage plans (Medicare Part C) also provides coverage for rehab as they cover everything Original Medicare covers along with some additional benefits. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.
Both Medicare Part C and Part D can each provide coverage for prescription drugs that are related to your rehab for drug or alcohol dependency.
How Much Does Rehab Cost?
Outpatient rehabs may cost from $3,000 to $10,000 for 90 days. Inpatient rehabs are more expensive, ranging from $5,000 to $20,000 for 30 days. Luxury rehabs range from $30,000 to $100,000 for 30 days.
Costs depends on what kind of rehab you need, where you get it, how long you need it and other factors.
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 Synvisc injections?