Yes, Medicare covers inpatient rehabilitation under Part A (Hospital Insurance), but only when your doctor certifies that your condition requires intensive therapy, ongoing medical supervision, and coordinated care from multiple providers. The bar for qualifying is higher than many people expect, and what you’ll pay out of pocket depends on how long your stay lasts.
Who Qualifies for Coverage
Medicare doesn’t cover inpatient rehab simply because your doctor recommends it. To qualify, you must need therapy from at least two disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics), and one of those must be physical or occupational therapy. You also need to be able to handle an intensive schedule: at least 3 hours of therapy per day, 5 days a week. In some cases, if a patient can’t sustain that daily pace, the requirement can instead be met with 15 hours of therapy spread across any 7 consecutive days starting from admission.
Before you’re admitted, a licensed clinician must complete a preadmission screening within 48 hours of your arrival. This evaluation documents your condition before the event that triggered the need for rehab, your expected level of improvement, how long recovery should take, your risk for complications, and where you’re likely to go after discharge. A rehabilitation physician must review and agree with these findings before the facility can admit you.
What Conditions Typically Qualify
Medicare requires inpatient rehabilitation facilities (IRFs) to discharge at least 60% of their patients with one of 13 qualifying conditions. This is known as the 60% Rule, and it shapes which patients facilities tend to accept. The qualifying conditions include stroke, spinal cord injury, major joint replacement, hip fracture, brain injury, and several neurological disorders. Having one of these conditions doesn’t guarantee admission, but it makes it far more likely the facility will accept you. If your condition falls outside this list, you may still qualify, but the facility will need stronger documentation that intensive rehab is medically necessary.
What You’ll Pay Out of Pocket
Inpatient rehab falls under the same Part A cost structure as a hospital stay. In 2025, you’ll pay a $1,676 deductible per benefit period, and Medicare covers the rest for the first 60 days. If your stay extends beyond that:
- Days 61 through 90: $419 per day in coinsurance
- Days 91 through 150: $838 per day, drawn from your 60 lifetime reserve days
A benefit period starts the day you’re admitted as an inpatient and ends once you’ve been out of a hospital or skilled nursing facility for 60 consecutive days. After that, a new benefit period begins and the 60 fully covered days reset. Lifetime reserve days, however, never reset. You get 60 total for your entire life, and each one you use is gone permanently.
Most inpatient rehab stays are well under 60 days. The average is roughly two to three weeks, so the majority of people pay only the deductible. If you have a Medicare Supplement (Medigap) plan, it may cover part or all of the deductible and coinsurance.
What’s Covered During Your Stay
Part A covers your semi-private room, meals, general nursing care, medications administered during your stay, and all therapy sessions. It also covers other hospital-level services and supplies that are part of your treatment plan. Medicare does not cover a private room unless it’s medically necessary, and it won’t pay for private-duty nursing.
Inpatient Rehab vs. Skilled Nursing Facilities
If you don’t meet the intensity requirements for an IRF, your doctor may recommend a skilled nursing facility (SNF) instead. The difference in therapy volume is substantial. IRF patients typically receive around 17.5 hours of therapy per week, while SNF patients average about 8.9 hours per week for comparable conditions like stroke recovery.
Medical oversight also differs considerably. At an IRF, a physiatrist (a doctor specializing in physical medicine and rehabilitation) evaluates you within 24 hours of arrival and sees you in person at least three times a week. Registered nurses are on-site around the clock. At a SNF, a physician is only required to evaluate you within 30 days of arrival and isn’t on-site 24/7. The average nurse-to-patient ratio at a SNF is 1 to 15, and nursing staff are only required to be available eight hours a day.
The coverage rules differ too. SNF coverage under Medicare requires a qualifying 3-day hospital stay beforehand. IRF admission has no such requirement. SNFs also have a different cost structure, with coinsurance kicking in after day 20 rather than day 60. If your medical team believes you can participate in intensive therapy and would benefit from closer physician oversight, an IRF is the stronger option. If your needs are less acute, a SNF may be more appropriate and still covered by Medicare.
What Can Lead to a Denial
The most common reason Medicare denies IRF coverage is a determination that the patient doesn’t need hospital-level rehabilitation. If your therapy needs could be met in a SNF, an outpatient clinic, or at home with home health services, Medicare considers the IRF stay not medically necessary. Denials also happen when documentation doesn’t support the expectation that you can tolerate and benefit from at least 3 hours of daily therapy, or when the preadmission screening is incomplete.
If your claim is denied, you have the right to appeal. The facility’s case manager or social worker can help you understand the reason for the denial and walk you through the appeals process, which starts with a redetermination request submitted to the Medicare Administrative Contractor that processed the claim.