Dear Marci,
My husband has a major surgery coming up, and his doctor said that after the surgery, he might need inpatient rehabilitation hospital care. Will his Original Medicare cover this?
-June (Fargo, ND)
Dear June,
Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive inpatient rehabilitation therapy. Someone may need inpatient care in a rehabilitation hospital if they 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 someone for care in a rehabilitation hospital include stroke, spinal cord injury, and brain injury. Your husband may not qualify for care if, as an example, he is recovering from hip or knee replacement and has no other complicating condition.
Medicare-covered services offered by rehabilitation hospitals include:
- Medical care and rehabilitation nursing
- Physical, occupational, or speech therapy
- Social worker assistance
- Psychological services
- Orthotic and prosthetic services
In order for your husband to qualify for a Medicare-covered stay in a rehabilitation hospital, his doctor must that that this care is medically necessary, meaning he must require all of the following services to ensure safe and effective treatment:
- 24-hour access to a doctor (meaning your husband requires frequent, direct doctor involvement, at least every 2-3 days)
- 24-hour access to a registered nurse with specialized training in rehabilitation
- Intensive therapy, which general means at least three hours of therapy per day (but exceptions can be made on a case-by-case basis—your husband may still qualify if he is 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 husband’s doctor must also expect that his condition will improve enough to allow him to function more independently after a rehabilitation hospital stay. For example, therapy may help him regain the ability to eat, bathe, and dress on his own, or live at home rather than living in a living facility.
If your husband qualifies for Medicare-covered care in a rehabilitation hospital, his out-of-pocket costs will be the same as for any other inpatient hospital stay. Keep in mind that if he enters a rehabilitation hospital after being an inpatient at a different facility, he will still be in the same benefit period. If he does not qualify for a Medicare-covered stay in an inpatient rehabilitation hospital, he may qualify for rehabilitation care from a skilled nursing facility, a home health agency, or an outpatient setting.
-Marci