What Are the Medicare Rules That Govern Coverage for Rehab?


Quick Answer

People with Medicare that need coverage for rehab must have a qualifying hospital stay and must get the services from a skilled nursing facility certified by Medicare. A person must have Part A coverage and some days left in the benefits period. A doctor must decide that a patient requires skilled care given by a skilled nursing staff, notes Medicare.

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Full Answer

Medicare Part A is an insurance coverage that covers skilled nursing care offered in a skilled nursing facility for a limited time. Some of the things covered include meals, skilled nursing care, medications, semi-private room, dietary counseling, ambulance transportation and speech-language services. Medicare covers these services if they are critical to fulfilling a person's health goal, notes Medicare. Skilled services are needed if the condition is due to a hospital-related problem.

Some conditions that may qualify a person to get Medicare rehabilitation coverage include brain injury, stroke and spinal cord injury, according to Medicare Interactive. Medicare considers nursing care for patients who are in a skilled nursing facility for skilled rehabilitation to be daily care even if it is just offered for 5 to 6 days a week. Days as an outpatient are not counted towards the 3-day inpatient stay required for Medicare to cover a person's rehab stay.

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