Rehabilitation services help people recover strength, mobility, and independence after serious illness, injury, surgery, or hospitalization. For seniors and certain disabled individuals, Medicare often becomes the primary payer for these important therapies. Families frequently want to know exactly how many days or weeks Medicare will continue paying for rehab care.
Medicare divides rehab coverage into different settings with very specific time limits and conditions. Inpatient rehabilitation in a hospital or skilled nursing facility follows strict rules under Part A. Outpatient therapy under Part B has no fixed day limit but depends on ongoing medical necessity.
Understanding these boundaries prevents surprises about costs or sudden discharge from covered rehab. Coverage is generous in the short term but requires careful documentation and progress toward clear goals. This guide explains the main types of rehab Medicare covers and how long payment typically continues.
Inpatient Rehabilitation Facility (IRF) Coverage
Medicare Part A covers care in an Inpatient Rehabilitation Facility when the patient needs intensive rehabilitation services that cannot be provided in a less intensive setting. To qualify, the patient must have a condition that requires at least three hours of therapy per day, five days per week. Common qualifying diagnoses include stroke, hip fracture, spinal cord injury, and certain neurological disorders.
Coverage begins after a qualifying three-day inpatient hospital stay. Medicare pays 100% of approved costs for the first 60 days (after the Part A deductible). Days 61 through 90 require a daily coinsurance amount, and lifetime reserve days (60 total over a lifetime) have a higher daily coinsurance.
Most IRF stays last 10 to 35 days, depending on the patient’s progress and ability to tolerate intensive therapy. Coverage ends when the patient no longer needs this level of care or reaches the benefit limits.
Skilled Nursing Facility (SNF) Rehabilitation
Medicare Part A covers rehabilitation in a Skilled Nursing Facility for up to 100 days per benefit period after a qualifying three-day inpatient hospital stay. The first 20 days are fully covered (after the Part A deductible). Days 21 through 100 require a daily coinsurance amount.
The patient must require daily skilled nursing or rehabilitation services that can only be provided in an SNF. Therapy must be reasonable and necessary to improve or maintain function. Coverage continues only while skilled care is needed.
Many patients complete rehab within the first 20 days or shortly after. If progress stalls or skilled needs end before day 100, Medicare stops paying even if the patient remains in the facility.
Outpatient Physical, Occupational, and Speech Therapy
Medicare Part B covers outpatient therapy (physical, occupational, and speech-language pathology) when it is medically necessary and provided by qualified therapists. Coverage has no strict annual visit limit but requires ongoing documentation of medical necessity and progress toward specific functional goals.
A physician or qualified non-physician practitioner must order therapy and certify the plan of care. The plan outlines measurable goals, frequency, duration, and expected outcomes. Certification is required every 90 days or sooner if changes occur.
Therapy continues as long as skilled care is needed to achieve or maintain those goals. Once goals are met or no further skilled improvement is expected, Medicare stops paying. Maintenance therapy to prevent decline without skilled need does not qualify.
Comparison of Medicare Rehab Coverage by Setting
Here’s a clear comparison of the main rehab settings Medicare covers:
| Setting | Covered Under | Maximum Covered Days per Benefit Period | Patient Cost After Deductible |
|---|---|---|---|
| Inpatient Rehabilitation Facility (IRF) | Part A | No fixed limit (based on medical necessity) | $0 days 1–60; daily coinsurance days 61–90; higher coinsurance reserve days |
| Skilled Nursing Facility (SNF) | Part A | 100 days | $0 days 1–20; daily coinsurance days 21–100 |
| Outpatient Therapy (PT/OT/SLP) | Part B | No fixed limit (medical necessity) | 20% coinsurance per visit |
This table shows how duration and cost-sharing differ across settings.
Therapy Caps and Thresholds in Outpatient Settings
Medicare no longer enforces hard annual dollar caps on outpatient therapy. Instead, a threshold amount triggers additional review. When spending exceeds this threshold, therapists must use the KX modifier on claims to confirm continued medical necessity.
A higher review threshold may trigger targeted medical record review by Medicare contractors. Most patients never reach these thresholds during a benefit period. Proper documentation of functional progress and skilled need prevents unnecessary reviews or denials.
Therapy can continue beyond thresholds when justified. Each benefit period stands on its own without lifetime limits for medically necessary outpatient therapy.
When Rehab Coverage Ends
Coverage ends when the patient meets therapy goals, no further skilled improvement is expected, or the patient no longer requires the level of care provided. The therapist documents the reason for discharge and communicates it to the physician and patient.
If a new condition or setback occurs later, therapy can restart with a new physician order and plan of care. No annual reset or lifetime cap exists for outpatient therapy under Part B. Each episode of care is evaluated independently.
In SNF and IRF settings, coverage ends when skilled needs resolve or the benefit period maximum is reached. Patients may transition to lower levels of care or private payment at that point.
Tips for Maximizing Medicare Rehab Coverage:
- Obtain a physician referral and order early to start coverage promptly.
- Attend all scheduled sessions to demonstrate commitment to progress.
- Keep a simple log of functional improvements to support documentation.
- Ask therapists to explain goals and expected outcomes clearly.
- Report any new symptoms or setbacks immediately to adjust the plan.
These practices strengthen medical necessity and support continued coverage.
Medicare Advantage and Rehab Coverage
Medicare Advantage plans must cover rehab services at least as well as Original Medicare. Many replace Part B 20% coinsurance with fixed copays per therapy visit, making budgeting easier. Some plans have visit limits or require prior authorization for extended therapy.
Inpatient rehab (IRF and SNF) follows the same Part A rules in Advantage plans. Out-of-pocket maximums cap total yearly spending, including rehab costs. In-network providers and facilities keep costs lowest.
Review plan documents during open enrollment. Switching plans may affect copays, visit limits, or preferred therapy providers.
Alternatives When Medicare Coverage Ends
When skilled therapy ends, many patients continue exercises at home or join community wellness programs. Senior centers, YMCAs, and local health departments often offer low-cost or free classes tailored to older adults. These maintain strength and balance without skilled supervision.
Medicaid covers additional therapy for eligible low-income individuals. Dual-eligible beneficiaries access both Medicare and Medicaid benefits. Long-term care insurance sometimes covers extended rehabilitation services.
Veterans may receive therapy through VA programs. Nonprofit organizations occasionally provide sliding-scale therapy for seniors.
Conclusion
Medicare covers rehabilitation services generously in the short term—up to 100 days in skilled nursing facilities, intensive IRF stays, and ongoing outpatient therapy as long as skilled care remains medically necessary. Coverage follows strict rules tied to progress, documentation, and specific settings. Medicare Advantage plans often provide lower copays and additional support. Working closely with therapists, physicians, and your plan ensures appropriate use of benefits while supporting recovery and long-term function. Early planning and clear communication prevent gaps and help achieve the best possible outcomes.
FAQ
How long does Medicare cover inpatient rehabilitation in a hospital or IRF?
Medicare Part A covers inpatient rehabilitation facility (IRF) care with no strict day limit as long as intensive therapy remains medically necessary. Coverage typically lasts 10–35 days for most patients. Daily coinsurance applies after day 60 in some cases.
How many days of skilled nursing facility rehab does Medicare cover?
Medicare Part A covers up to 100 days of skilled nursing facility rehabilitation per benefit period after a qualifying three-day hospital stay. Days 1–20 are fully covered (after deductible); days 21–100 require daily coinsurance. Coverage ends when skilled needs resolve or day 100 is reached.
Does Medicare cover outpatient physical therapy without a visit limit?
Medicare Part B covers outpatient physical therapy with no strict annual visit limit when medically necessary. A threshold amount triggers additional documentation requirements. Coverage continues as long as skilled care is needed to achieve or maintain functional goals.
What happens when Medicare stops paying for physical therapy?
Coverage ends when therapy goals are met, no further skilled improvement is expected, or maintenance care is all that remains. Patients can continue exercises independently or pay privately. A new condition or setback allows therapy to restart with a new order.
Does Medicare Advantage cover rehab differently?
Medicare Advantage plans cover rehab at least as well as Original Medicare. Many replace 20% coinsurance with fixed copays per visit. Some plans have visit limits or require prior authorization. Out-of-pocket maximums cap total yearly costs.
Is home health physical therapy covered by Medicare?
Yes, Medicare covers home health physical therapy when the patient is homebound and requires skilled care. Coverage falls under home health rules with 100% payment for approved visits. Homebound status means leaving home requires considerable effort.
Does Medicare cover speech therapy or occupational therapy?
Yes, Medicare Part B covers speech-language pathology and occupational therapy under the same rules as physical therapy. Coverage requires medical necessity, a physician order, and a plan of care with measurable goals. The 20% coinsurance applies after the deductible.
Are there lifetime limits on Medicare rehab coverage?
No, Medicare has no lifetime limit on medically necessary rehab services. Each benefit period or episode of care is evaluated independently. Outpatient therapy continues as long as skilled need exists; SNF and IRF coverage follows per-period limits.
What costs will I pay for Medicare-covered rehab?
For outpatient therapy, you pay 20% coinsurance after the Part B deductible. Inpatient rehab (IRF/SNF) involves the Part A deductible and daily coinsurance after day 20 or 60 depending on setting. Advantage plans often use fixed copays instead.
How do I know if my therapy is still covered by Medicare?
Your therapist documents progress toward specific functional goals. Coverage continues while skilled care is needed and improvement or maintenance of function is expected. Ask your therapist and physician to explain the plan of care and expected duration.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.