Aetna Medicare Advantage and Aetna Medicare Supplement policies work differently when you need rehabilitation. First identify the product on your card. The company name alone does not tell you who approves care, which network applies or how costs are shared.
Start with the type of coverage
| Coverage | How rehabilitation is handled |
|---|---|
| Aetna Medicare Advantage | The plan administers covered benefits; verify network, authorization and its cost schedule. |
| Original Medicare with Aetna Medigap | Medicare determines covered services; the supplement helps with costs listed in its policy. |
Medigap does not generally pay for a service Medicare excludes or supplement Medicare Advantage copays. Do not use an Advantage Evidence of Coverage to interpret a Supplement policy.
Identify the care setting
An inpatient rehabilitation hospital, skilled nursing facility and outpatient therapy office have different eligibility and payment rules. Inpatient rehabilitation requires intensive coordinated care and medical supervision. SNF care requires its applicable admission and ongoing skilled-care conditions. Outpatient therapy requires medically necessary skilled services and appropriate certification.
The SNF 100-day maximum is not a universal rehabilitation allowance or an automatic approval. An Aetna plan may have copays during the first 20 SNF days. Obtain the actual schedule instead of assuming Original Medicare’s cost-sharing applies.
Questions for Aetna and the provider
- Is this facility and professional covered under my exact plan?
- Does this admission or therapy require prior authorization?
- Who submits the request, and what does approval include?
- What are facility, professional and optional charges?
- How will continued medical need be reviewed?
- What happens if the care setting changes?
Use the current plan-year documents and the member-service number on your card. Keep the written response and reference number.
Plan beyond the covered service
Rehabilitation coverage is different from permanent room and board or personal assistance alone. Ask the care team about discharge support and the facility about separate charges. Read any denial or end-of-coverage notice promptly and follow the appropriate review process. This article does not publish a single Aetna price or promise approval for a particular stay.
Related coverage questions
- Medicare Rehabilitation Coverage: Compare Care Settings
- Medicare Part B Physical Therapy: Coverage and Costs
- Medicare Part B Rehabilitation: Outpatient Therapy Coverage