Inpatient Rehabilitation Care
This content is for informational purposes only. For medical advice or diagnosis, consult a healthcare professional. In case of an emergency, immediately call 911.
Inpatient rehabilitation services provide intensive therapy for patients recovering from serious surgery, illness, or injury. This level of care is designed for individuals who require a coordinated team of doctors and therapists, including at least three hours of intensive therapy per day (such as physical, occupational, or speech therapy).
Coverage and Benefits
Medicare Part A
- Qualification: Inpatient rehabilitation is covered under Medicare Part A (Hospital Insurance) when a physician certifies that the patient requires intensive rehabilitation, ongoing medical supervision, and coordinated interdisciplinary care. Services must be provided in a specialized Rehabilitation Hospital or a dedicated inpatient rehabilitation unit of a general hospital.
- Qualifying Stay: For most facilities, transfer to a rehabilitation facility following a qualifying inpatient hospital stay is a standard requirement. Certain inpatient rehabilitation facilities (IRFs) may apply specific clinical criteria for admission based on the intensity of therapy needed.
- Coverage: Covers semi-private rooms, meals, general nursing, drugs provided as part of inpatient treatment, and other hospital services and supplies. Private rooms and private-duty nurses are not covered.
- Duration of Care: Medicare Part A coverage is measured by benefit period. A benefit period begins on the day of admission. If a patient is readmitted within 60 days of discharge, it counts as the same benefit period. If readmitted after 60 days, a new benefit period begins—resetting the day count and triggering a new deductible.
- Patient Cost: After meeting the Part A deductible of $1,736, there is $0 coinsurance for days 1–60, $434 per day for days 61–90, and $868 per day for day 91 and beyond (lifetime reserve days). After reserve days are used, the patient pays full cost.
Medicare Part B (Physician Services)
- Coverage: Covers physician and specialist services received while you are an inpatient.
- Patient Cost: After meeting the annual Part B deductible ($283 in 2026), Medicare covers 80% of the approved cost for physician services, and the patient pays the remaining 20%.
*Even during an inpatient stay, physician services are billed separately under Part B and not Part A.
Medicaid (NJ FamilyCare)
- Coverage: NJ FamilyCare covers inpatient rehabilitation services when they are medically necessary and prescribed by a physician. Coverage typically includes room and board, nursing care, and rehabilitative therapies.
- Cost Sharing: For most NJ FamilyCare beneficiaries, there is a $0 copayment for inpatient services
- Prior Authorization: Most Medicaid Managed Care Organizations (MCOs) in New Jersey require prior authorization from the insurance provider before admission to a rehabilitation facility.
Private Insurance
- Coverage: Most private health plans cover inpatient rehabilitation, but the duration and facility types depend on the specific policy.
- In-Network vs. Out-of-Network: Patients are protected from balance billing for certain services. However, for non-emergency inpatient rehab, using in-network facilities is essential to minimize out-of-pocket costs.
- Clinical Review: Private insurers often require concurrent review—periodically checking the patient’s progress to determine whether continued inpatient care remains medically necessary.
Cost Sharing by Insurance Type (2026)
Rehabilitation Facilities Search
Inpatient Rehabilitation Providers in Bergen County
The following are non-emergency contacts. In case of an emergency, immediately call 911.
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