Stroke rehabilitation involves intensive physical, occupational, and speech therapies. For most Americans who experience a stroke, Medicare serves as the primary payer for the necessary recovery costs. The duration of coverage is not fixed; it depends on the medical necessity of the services and the specific setting where care is delivered. Understanding the difference between Medicare’s hospital insurance (Part A) and medical insurance (Part B) is the first step in determining how long financial support for rehabilitation will last.
Initial Coverage Requirements and Care Settings
Before Medicare covers any post-stroke rehabilitation, the services must be deemed “medically necessary” and “reasonable.” A physician must certify that the therapy is expected to improve the patient’s condition in a measurable way or maintain functional status to prevent further decline. Medicare generally does not cover purely custodial care, such as assistance with daily living activities that does not require a skilled professional.
The location of care dictates the coverage rules. The initial, intensive phase of recovery often takes place in an Inpatient Rehabilitation Facility (IRF) or a Skilled Nursing Facility (SNF), both covered by Medicare Part A. An IRF provides intensive, multidisciplinary therapy, requiring patients to participate in at least three hours of therapy per day, five days a week. An SNF offers a less intense level of skilled care, including daily skilled nursing or therapy services.
Once stable, patients may transition to care at home or an outpatient clinic, which falls under Medicare Part B. Part A covers facility stays (hospital insurance), while Part B covers doctors’ services, outpatient care, and durable medical equipment (medical insurance). The duration limits and cost-sharing change depending on which part of Medicare pays for the services.
Fixed Duration Coverage in Skilled Nursing Facilities
A stay in a Skilled Nursing Facility (SNF) often follows the acute hospital phase, and Medicare Part A applies a specific time limit here. To qualify for SNF coverage, the patient must first have a “qualifying inpatient hospital stay” of at least three consecutive days. This “3-midnight rule” only counts time formally admitted as an inpatient, excluding observation status. Admission to the SNF must occur within 30 days of hospital discharge.
If the patient meets the qualifying stay requirement and still needs daily skilled care, Medicare Part A covers a maximum of 100 days per benefit period. A benefit period begins upon admission to a hospital or SNF and ends only after the patient has been out of either facility for 60 consecutive days.
Medicare Part A fully covers the first 20 days of the SNF stay, meaning the patient owes a $0 co-payment after the Part A deductible is satisfied. For days 21 through 100, the patient is responsible for a daily co-insurance payment. After the 100th day of the benefit period, Medicare Part A stops paying entirely, and the patient is responsible for all SNF costs.
Receiving the full 100 days is not guaranteed; coverage ceases sooner if the patient no longer requires daily skilled services. If a patient exhausts their 100 days, they can become eligible for a new 100-day period only after a new benefit period has started. This reset requires the patient to spend 60 consecutive days out of a facility before a subsequent qualifying hospital stay triggers new coverage.
Ongoing Outpatient and Home Health Services
Once the stroke survivor is discharged from a facility, rehabilitation often continues under Medicare Part B, which is not bound by a fixed day limit. Outpatient physical, occupational, and speech therapy services are covered as long as they are medically necessary for recovery or maintenance of function. Part B coverage continues as long as the provider documents that the patient is making progress or requires skilled intervention to prevent deterioration.
The patient’s financial responsibility for Part B services involves an annual deductible and a 20% coinsurance of the Medicare-approved amount for each session. Although the duration is not capped, the patient must cover one-fifth of the service cost after meeting the deductible.
For patients who are considered homebound, Medicare can cover skilled services through the Home Health benefit. This coverage is provided as long as the patient requires intermittent skilled nursing care or skilled therapy. Home Health services, including physical and speech therapy delivered at the residence, are typically covered at 100% of the cost with no deductible. This benefit provides an alternative setting for continued recovery without the daily limits or co-insurance associated with an SNF stay.