If a patient had surgery with more than a 3 day stay in the hospital and needed to recover from the surgery before starting rehab, can the rehab stay be delayed by up to 90 days pending recovery?
The 2025 Medicare and your handbook discusses the complications, including outpatient observation status versus an inpatient admission. When considering Medicare, covering the cost of part A skilled nursing and a skilled nursing facility. If a person has a Medicare advantage plan, they may have to pay a copay for up 100 hundred days in a skilled nursing facility, depending on there are particular guidelines in the Medicare advantage plan. If they own a Medicare supplement and they meet all the requirements for coverage in a skilled nursing facility under Medicare part A, they will be covered for a maximum of 100 days of skilled nursing with no cost on their part.
Yes with a couple of caveats. Medicare will pay for inpatient rehab in a skilled nursing as long as the rehab stay is preceded by a 3 day stay in a hospital. This is called the "Medicare 3-day rule." And it is true that beginning the rehab stay can be delayed by up to 90 days after the hospital stay, pending recovery from the surgery. However, if the delay is longer than 30 days, it must be medically inappropriate to begin rehab sooner to remain covered. Also, the above rules apply to Original Medicare. If someone is enrolled in a Medicare Advantage plan, they will have to follow the guidelines set forth by their particular plan. Medicare Advantage members are not subject to the 3-day rule, but their plan will still have to approve any inpatient rehab stay based on medical necessity.
Yes, Medicare may allow for a delay in starting inpatient rehabilitation (SNF) after surgery, potentially up to 90 days, provided the patient has a qualifying three-day inpatient hospital stay and needs time to recover before beginning rehab. Medicare Part A generally covers SNF care after a qualifying hospital stay
Yes. Medicare allows a rehab stay to start up to 90 days after a qualifying 3-day hospital stay if there’s a documented medical reason, like needing time to recover from surgery before beginning rehab.
While the standard admission to a Skilled Nursing Facility is within 30 days of hospital discharge, it can be delayed up to 60 days, if medically necessary, but not 90 days.
They can delay the rehab. If the patient delays the stay after 60 days from the time they are first admitted to the hospital they may need to pay a second deductible or start their copays over depending on how they are covered.
Medicare generally requires admission to a skilled nursing facility (SNF) within 30 days of hospital discharge for coverage. However, this 30-day rule can be overridden if it's determined that an immediate SNF admission is medically inappropriate based on the patient's condition and established treatment plan. In such cases, if it's medically predictable at the time of hospital discharge that SNF care will be needed within a defined future timeframe, coverage for that deferred care may still apply
It is always important that both you and your agent go over the summary of benefits and evidence of coverage to know more in detail about the plan.
Yes, Medicare may allow for a delay in starting inpatient rehabilitation (SNF) after surgery, potentially up to 90 days, provided the patient has a qualifying three-day inpatient hospital stay and needs time to recover before beginning rehab. Medicare Part A generally covers SNF care after a qualifying hospital stay
