The short answer to this question is yes, inpatient rehabilitation facilities are covered under Medicare. But it is helpful to be familiar with the definitions, rules and conditions that apply to this coverage.
An inpatient rehabilitation facility (IRF) is a specialty hospital or a part of an acute care hospital that provides intensive rehabilitative care. According to Medicareinteractive.org, "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 from a team or medical professionals that generally cannot be provided in another setting (such as in your home or a skilled nursing facility)."
Medicare.gov clarifies that IRF admissions are covered under Medicare Part A, or hospital insurance. The benefits paid by Medicare for an inpatient rehabilitation facility are the same as inpatient hospital care. As with a stay an acute care hospital, private rooms, private nurses and items that may cost extra (such as a TV or socks) are not covered. Depending on how long you stay in the facility, copayments may apply.
For Medicare to cover an inpatient rehabilitation facility, your doctor needs to certify that you will need:
- Intensive physical or occupational therapy treatment for three or more hours a day for at least five days a week.
- 24/7 access to a rehabilitation doctor, including at least three visits a week.
- 24/7 access to a rehabilitation nurse.
- At least one more type of rehabilitation in addition to the primary rehab. This could include speech therapy or help adjusting to a prosthetic.
If your doctor doesn't think that you require the intensive rehabilitation provided by an IRF, they may request that you be transferred to a skilled nursing facility instead. Skilled nursing facilities have different Medicare requirements, however. Navigating Medicare benefits for seniors can be confusing, and we would like to help.
At Caring Senior Service, our expert staff is comprised of extremely knowledgeable, friendly, and trusted professionals who take pride in helping your loved one manage their daily activities. Contact us today to learn more!