Hip replacement surgery is a major orthopedic procedure, and recovery often involves a period of rehabilitation (rehab) to restore mobility and strength. If you’re a Medicare beneficiary, it’s essential to understand how long Medicare pays for rehab after a hip replacement, what services are covered, and the limitations involved.
Does Medicare Pay for Rehab After Hip Replacement Surgery?
Yes, Medicare does pay for rehab after hip replacement surgery if the services are considered medically necessary. This typically includes:
- Inpatient rehabilitation facility (IRF) care
- Skilled nursing facility (SNF) rehab
- Outpatient physical therapy
- Home health services
Coverage depends on your specific Medicare plan (Original Medicare vs. Medicare Advantage), the type of rehab setting, and whether certain requirements are met.
What Is the 21-Day Rule for Medicare?
The “21-day rule” refers to Medicare’s coverage of skilled nursing facility (SNF) care. After a qualifying 3-day inpatient hospital stay, Medicare covers 100% of SNF rehab costs for the first 20 days. Beginning on day 21 through day 100, you’ll pay a daily coinsurance.
- Days 1–20: $0 (fully covered by Medicare Part A)
- Days 21–100: You pay a daily coinsurance (e.g., $204 per day in 2025, subject to annual changes)
- After 100 days: You are responsible for all costs unless you have a Medicare Supplement (Medigap) or other secondary insurance
How Many Days of Inpatient Rehab Does Medicare Cover?
If you are admitted to an inpatient rehab facility (IRF) after your hip replacement, Medicare Part A covers up to 90 days per benefit period, plus an additional 60 lifetime reserve days. However, you must meet the following conditions:
- You need intensive rehab services that require a multidisciplinary team
- The services are medically necessary and certified by your physician
- The facility is Medicare-certified
The cost breakdown generally looks like this:
- Days 1–60: $0 coinsurance
- Days 61–90: Daily coinsurance applies (e.g., $408/day in 2025)
- Days 91–150: Use of lifetime reserve days with higher coinsurance
- After 150 days: You pay 100% of costs
How Long Does a Patient Stay in Rehab After Hip Replacement?
The length of stay in rehab after a hip replacement varies based on:
- Age and overall health
- Type of surgery (partial vs. total hip replacement)
- Recovery progress
- Rehab setting (inpatient vs. outpatient)
Typically:
- Inpatient rehab facility: 10 to 14 days
- Skilled nursing facility: Up to 20–30 days, depending on patient progress
- Home health rehab: Varies; 2–3 sessions/week for 4–6 weeks
- Outpatient rehab: Can last 6 to 12 weeks or longer, depending on goals
Your doctor and care team will tailor the rehab duration to your individual recovery needs.
What Happens If You Need More Rehab Time?
If your rehab exceeds Medicare’s covered limits, you may:
- Pay out-of-pocket
- Use Medigap insurance (which can help cover coinsurance or extended rehab)
- Switch to outpatient therapy, which is covered under Medicare Part B
- Consider home health care, if eligible
Always check with your Medicare plan or a licensed Medicare advisor to understand your exact coverage.
Final Thoughts
Medicare provides extensive rehab coverage after hip replacement, but knowing the limits, rules, and cost-sharing responsibilities is crucial for a smooth recovery. The key is meeting Medicare’s criteria, staying within benefit periods, and coordinating with your care providers.
For seniors recovering from hip surgery, a clear understanding of how long Medicare pays for rehab after hip replacement can reduce stress and help plan for the journey ahead.
