Hip replacement surgery is a common and highly effective treatment for chronic joint pain. Rehabilitation, which involves physical therapy and skilled care, is necessary to restore mobility and function to the new joint. Medicare coverage for this post-operative recovery is extensive, but it is split across different parts of the program. Coverage depends heavily on where the care is received and the type of plan the beneficiary has. Understanding the specific rules for inpatient facility stays versus ongoing outpatient therapy is the first step in managing your recovery and financial obligations.
Part A Coverage for Short Term Facility Care
The immediate, intensive rehabilitation phase often requires a short stay in a specialized facility, which falls under Medicare Part A, or Hospital Insurance. Part A covers medically necessary care in a Skilled Nursing Facility (SNF) or an Inpatient Rehabilitation Facility (IRF) after a qualifying hospital stay. These facilities provide a high level of daily skilled nursing and therapy services, which are critical in the first weeks following hip surgery.
To qualify for Part A coverage in an SNF, you must have been admitted as a hospital inpatient for at least three consecutive days before the SNF admission. Time spent under “observation status” in the hospital does not count toward this three-day requirement. If you meet this requirement, Medicare covers up to 100 days of SNF care per benefit period.
The benefit period begins the day you are admitted as an inpatient and ends when you have been out of a hospital or SNF for 60 days in a row. For the first 20 days of a covered SNF stay, Medicare pays the full cost of your care. From day 21 through day 100, the beneficiary is responsible for a daily coinsurance payment, after which all costs are the patient’s responsibility.
Part B Coverage for Ongoing Therapy and Equipment
Once the acute rehabilitation phase is complete, the focus shifts to ongoing recovery, which is covered by Medicare Part B, or Medical Insurance. This coverage handles less intensive, outpatient services and the durable medical items needed for mobility. Part B pays for medically necessary outpatient physical therapy (PT) sessions, which are typically received at a clinic, a therapist’s office, or a hospital outpatient department.
There is no annual limit on how much Medicare will pay for medically necessary outpatient therapy, but the provider must confirm that the services remain necessary after a certain spending threshold is met. Part B also covers Durable Medical Equipment (DME) when prescribed by a doctor for use in the home. This includes items like a walker, crutches, or a wheelchair to assist with mobility during the recovery period.
Additionally, Part B contributes to covering medically necessary home health care if you are considered homebound and require intermittent skilled nursing care or therapy services. These services are often provided by a home health agency to transition a patient back to independent living. The coverage for these services is distinct from long-term, non-medical custodial care, which Medicare does not cover.
Your Costs for Post Surgery Rehabilitation
Beneficiaries are responsible for certain out-of-pocket costs, which can vary based on the care setting and duration, even with coverage from Original Medicare (Parts A and B). For Part A coverage, a deductible must be met for each benefit period before Medicare begins to pay for inpatient services, which is set at $1,676 in 2025. If the hospital stay meets this deductible, the initial cost for the SNF stay is covered.
For the short-term SNF stay, the patient pays nothing for the first 20 days of care after meeting the Part A deductible. A daily coinsurance of $209.50 for 2025 applies for days 21 through day 100 of the SNF stay. Beyond 100 days in a benefit period, the patient is responsible for the full cost of facility care.
Part B costs are separate and apply to all outpatient rehabilitation services and DME. In 2025, the Part B annual deductible is $257, which must be paid before coverage begins. After the deductible is met, the patient is generally responsible for 20% of the Medicare-approved amount for each physical therapy session and for the cost of Durable Medical Equipment.
How Medicare Advantage Plans Handle Rehab
Medicare Advantage Plans, also known as Part C, offer a different way to receive Medicare benefits, including post-surgery rehabilitation. These plans are offered by private insurance companies approved by Medicare and must cover at least the same services as Original Medicare (Parts A and B). This means a Part C plan will cover both the inpatient facility stay and the outpatient therapy following hip surgery.
However, the specific costs and rules for accessing care under Part C plans can differ significantly from Original Medicare. These plans often utilize different cost-sharing structures, such as fixed copayments for SNF stays or physical therapy visits, rather than the coinsurance model of Original Medicare. You may also be required to obtain prior authorization from the plan before receiving facility or in-home care.
Part C plans typically operate with a network of approved providers and facilities. You must use in-network rehabilitation centers and therapists to ensure the lowest out-of-pocket costs. While these plans may offer lower overall out-of-pocket costs or additional benefits, they come with less flexibility in choosing where to receive your rehabilitation care.