Many hip surgery patients are discharged from the hospital before they’re ready to live independently at home. Skilled nursing facilities like Bella Vista Health Center in San Diego provide a safe and comfortable place for patients to transition back to independent living. With access to a range of healthcare providers and rehabilitative services, residents are empowered to participate in their recovery while receiving the care they need to restore strength and functioning and get back to their personal best. 

At Bella Vista Health Center, we often field calls from patients who have recently undergone or are preparing to undergo hip surgery, and who want to know if Medicare pays for rehab after hip surgery.  The short answer is yes. But that wasn’t the case just two years ago. Prior to 2020, total hip surgery was on a list of procedures that only qualify for inpatient medicare coverage, not rehabilitation coverage. In 2020, however, total hip surgery was removed from that list, making it available now for rehabilitation coverage through Medicare. There are, however, some stipulations, which we’ll cover in the longer answer below. Read on for more information about Medicare and hip surgery rehab.

Medicare and inpatient rehabilitation

If you’re enrolled in Medicare Part A, you’ll be happy to know that it covers medically necessary inpatient rehab care as long as your condition and the facility meet the qualifying requirements. 

First, your rehabilitation must be confirmed by your doctor as a medical necessity that requires:

• Intensive rehabilitation

• Continued medical supervision

• Coordinated care from doctors and rehabilitation specialists

Additionally, your hip surgery rehabilitation must also take place in a qualifying facility, which includes:

• Skilled nursing facility

• Inpatient rehab facility

• Acute care rehab center

• Rehabilitation hospital

It’s important to note that Medicare will only cover your rehabilitation if your initial hospital stay consists of three consecutive days at a Medicare-approved hospital.  Overnight stays for testing or observation, emergency room visits, and discharge days do not count toward the three-day rule.  Certain other procedures on Medicare’s “inpatient only” list do not qualify rehabilitation coverage and cannot count toward the three-day rule. Hip replacement surgery and knee replacement surgery used to be on that list, but both were removed (in 2020 and 2018, respectively) and are now covered as long as other requirements are met. 

Medicare and rehabilitation coverage

Your stay in Bella Vista Health Center’s skilled nursing facility or other qualifying rehabilitation facility will be covered by Medicare, and nearly everything will be paid for, including:

• Rehabilitation therapies

  • Physical therapy

  • Occupational therapy

  • Speech and language therapy

• Nursing services

• Medical social services

• Dietary counseling

• Meals

• Medications

• Other hospital services and supplies 

• A semi-private room

A few things not covered by Medicare include:

• A private room (unless deemed medically necessary)

• Private nurses

• A television or a phone in your room

• Socks, toothpaste, razors, or other personal items (except those provided by the facility as part of your stay)

In a skilled nursing facility, Medicare covers your rehabilitation for up to 100 days.  For the first 20 days, the only amount you’ll need to pay is your $1,364 deductible. However, if you’ve already met your deductible through the hospital stay immediately prior to being transferred to the skilled nursing facility, you will not need to pay it again. From days 21 to 100, you’ll be responsible for a $185.50 copay per day. And after 100 days, you’ll be responsible for all costs incurred. 

The above information is general and meant to provide you with a ballpark estimate of standard coverage, but there may be additional information regarding your medicare coverage.  The best way to determine how much you’ll pay out of pocket or what your plan covers is to check with your plan provider for details. The more information you have going into your hip replacement surgery, the more you’ll be able to focus on your recovery when it’s over. 

Looking for hip surgery rehabilitation in San Diego? Visit Bella Vista Health Center

At Bella Vista Health Center in San Diego, we offer a wide range of top-notch rehabilitative services, including comprehensive hip surgery rehabilitation programs. If you’re looking for hip surgery rehab for yourself or for someone you love, give us a call at (619) 444-1000 or come visit our 5-star skilled nursing facility in Lemon Grove today.