|  | Healthcare Industry | Medicare

Medicare Rehab Requirements

There are certain requirements that must be met in order for Medicare to cover rehab services received in a Skilled Nursing Facility (SNF). These include the number of days left within your Medicare Part A benefits, the type of services required and a need for a qualifying hospital stay. The information in this article explains rehab coverage for traditional Medicare. If you receive health care from a HMO or PPO, the requirements may be different.

  1. Qualifying Hospital Stay

    • A three-day hospital stay is required before entering rehabilitation

      You must be listed as an inpatient and not as an observation patient for three consecutive days at a hospital. Most of the time, you will be transferred directly from the hospital to the SNF. Occasionally, you can be admitted for rehab from home. However, you must have spent a qualifying three-day hospital stay within the previous 30 days in order for Medicare to pay for the rehabilitation stay. If you leave the SNF rehab center and re-enter a SNF again within 30 days, you may not need an additional qualifying hospital stay.

    Rehab Requirements

    • Rehab services must be provided on a daily basis.

      A physician has to order the services you need for SNF rehab, such as care by nurses, physical therapists, occupational therapists or speech therapists. The care must occur on a daily basis and the services must only be provided in an SNF. If you are in an SNF for skilled rehabilitation services only (minimal nursing care), your care is considered daily care even if the therapy services are offered less often. Physical and occupational therapy is sometimes only available five or six times a week.

    Medicare Part A Coverage

    • Medicare part A can pay towards your first 100 days in rehab

      You can receive up to 100 days of SNF rehabilitation care within a benefit period. A benefit period begins on the day you begin using hospital or SNF rehab benefits under the Part A portion of your Medicare plan. The first 20 days are paid in full, and the remaining 80 days require a co-payment. Medicare Part A will not cover long-term care or custodial care. This type of care may be covered by Medicaid.

      If you are not sure if you have Part A, look on your "red, white, and blue" Medicare card. It will show "Hospital (Part A)"on the front of the card if you have it. You can also call Social Security at 1-800-772-1213.

Medicare - Related Articles