Mom broke her hip. Will Medicare pay for rehab?

Updated October 6, 2026 · General information, not professional advice

Will Medicare pay for rehab after a broken hip?

In most cases, yes. A hip fracture almost always means surgery and a hospital stay, and Medicare covers the rehab that follows when a doctor says it is medically necessary. What changes is where she gets rehab and how much your family pays.

There are four common paths after the hospital:

• Inpatient rehabilitation facility (IRF): a rehab hospital or unit with intensive daily therapy and close doctor oversight.
• Skilled nursing facility (SNF): short-term rehab in a nursing home that is Medicare-certified.
• Home health care: therapists and nurses visit her at home if she is homebound.
• Outpatient therapy: she travels to a clinic for physical therapy, covered under Part B.

Inpatient rehab facility vs. skilled nursing: which one?

The hospital team (doctor, therapists and case manager) recommends a setting based on how much therapy she can handle.

• Inpatient rehab is for patients who can take part in an intensive program, generally about three hours of therapy a day, at least five days a week, and who need a doctor's ongoing supervision.
• Skilled nursing rehab is for patients who need daily skilled nursing or therapy but cannot yet tolerate that pace. Many hip fracture patients go here first.

You can ask the case manager for a list of facilities with open beds and tell them your preferences. You are not required to accept the first place offered.

What rehab costs with Original Medicare in 2026

Inpatient rehab facility (2026):

• Days 1 to 60: $0 after the $1,736 Part A deductible. If she already paid the deductible for the hospital stay in the same benefit period, she usually does not pay it again.
• Days 61 to 90: $434 per day.
• Days 91 and beyond: $868 per day using lifetime reserve days.

Skilled nursing facility (2026):

• Days 1 to 20: $0.
• Days 21 to 100: $217 per day.
• After day 100: she pays all costs.

A Medigap (Medicare Supplement) policy often pays some or all of these amounts. Medicare Advantage plans set their own copays and often require prior approval for rehab.

The rule that catches families off guard

For skilled nursing rehab under Original Medicare, Mom must have had a medically necessary inpatient hospital stay of at least 3 days in a row. Time spent under "observation" does not count, even if she slept in a regular hospital bed.

Ask the nurse or case manager directly: "Is my mother an inpatient or an outpatient under observation?" Hip fracture surgery usually means inpatient admission, but always confirm. She must also generally enter the skilled nursing facility within 30 days of leaving the hospital.

Inpatient rehab facilities do not have the same 3-day requirement; they need a doctor to certify that she needs intensive rehab.

Steps to take before discharge

1. Ask what setting the team recommends and why.
2. Confirm her inpatient status and the number of inpatient days.
3. If she has a Medicare Advantage plan, ask whether the plan has approved the rehab facility and which ones are in-network.
4. Check the facility's ratings and inspection history on Medicare's Care Compare tool.
5. Get the discharge plan in writing, including therapy goals and follow-up appointments.

If you want help comparing options, seniorcare.si can show licensed rehab and skilled nursing facilities near your ZIP code.

If Medicare says rehab is ending too soon

Rehab coverage depends on her continued need for skilled care, not on a fixed number of days. If the facility plans to stop Medicare-covered services, it must give her a written notice, usually at least two days before coverage ends. That notice explains how to ask for a fast appeal through the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on the form.

Call the number on the notice by the deadline it states. An independent reviewer decides, usually within a few days. Keep notes on her progress, falls, pain and what the therapists say; these details help an appeal.