Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive inpatient rehabilitation therapy. You may need Inpatient care in a rehabilitation hospital if you are recovering from a serious illness, surgery, or injury and require a high level of specialized care that generally cannot be provided in another setting (such as in your home or a skilled nursing facility).
Examples of common conditions that may qualify you for care in a rehabilitation hospital include stroke, spinal cord injury, and brain injury. You may not qualify for care if, as an example, you are recovering from hip or knee replacement and have no other complicating condition.
Medicare-covered services offered by rehabilitation hospitals include:
- Medical care and rehabilitation nursing
- Physical, occupational, and speech therapy See Speech-Language Pathology.
- Social worker assistance
- Psychological services
- Orthotic and prosthetic services
To qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. , meaning you must require all of the following services to ensure safe and effective treatment:
- 24-hour access to a doctor (meaning you require frequent, direct doctor involvement, at least every 2-3 days)
- 24-hour access to a registered nurse with specialized training or experience in rehabilitation
- Intensive therapy, which generally means at least three hours of therapy per day (but exceptions can be made on a case by case basis—you may still qualify if you are not healthy enough to withstand three hours of therapy per day)
- And, a coordinated team of providers including, at minimum, a doctor, a rehabilitation nurse, and one therapist
Your doctor must also expect that your condition will improve enough to allow you to function more independently after a rehabilitation hospital stay. For example, therapy may help you regain the ability to eat, bathe, and dress on your own, live at home, and/or live with family rather than in a living facility.
If you qualify for Medicare-covered care in a rehabilitation hospital, your out-of-pocket costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them. will be the same as for any other inpatient hospital stay. Keep in mind that if you enter a rehabilitation hospital after being an inpatient at a different facility, you will still be in the same benefit period The benefit period is the amount of time during which Medicare pays for hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. With each new benefit period, you pay a new deductible. Your coinsurance is determined by the number of days you have been in the facility during each benefit period. . If you do not qualify for a Medicare-covered stay in an inpatient rehabilitation hospital, you may qualify for rehabilitation care from a skilled nursing facility, a home health agency, or in an outpatient An outpatient is a patient who has not been formally admitted into the hospital as an inpatient. Most outpatient care is covered under Medicare Part B (medical insurance). setting.