Whether you’ve already spent time researching options or this is your starting point, feeling confident about your insurance decision starts with understanding the pros and cons of the options. Here you’ll find a basic breakdown of Medicare plan options, a walkthrough of the rehabilitation approval process, questions to consider, and resources to learn more.
Understanding your Medicare options.
Before we dive into how these choices affect rehabilitation, let’s break down the basics.
Traditional Medicare (Parts A & B)
Traditional Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working. The monthly 2025 cost of Part B is $185.
Traditional Medicare doesn’t cover everything. Seniors are responsible for deductibles, coinsurance, and copayments. That’s why most people on Traditional Medicare also purchase a Medicare Supplement plan (also called Medigap), which typically costs between $30 and $300+ per month depending on location, age, and the plan selected.
Medicare.gov states that while premiums vary widely (and increase over time) based on where insurance companies set them, “The benefits in each lettered plan are the same, no matter which insurance company sells it. The premium amount is the only difference between policies with the same plan letter sold by different companies. There can be big differences in the premiums that different insurance companies charge for the same coverage, so be sure you compare Medigap plans with the same letter (for example, compare Plan G from one company with Plan G from another company).”
Medicare Advantage plans
Medicare Advantage plans (sometimes called Part C) are offered by private insurance companies approved by Medicare. These plans bundle your Part A and Part B coverage together, and often include prescription drug coverage too.
Medicare Advantage plans typically have lower, more predictable monthly premiums. You know exactly what you’ll pay each month, which can be a huge relief if you’re on a fixed income. In 2026, the average Medicare Advantage premium is projected to be around $14 per month, though this varies by plan.
Medicare Advantage makes sense for many people—particularly those who need predictable costs and want to avoid the higher monthly expenses of Traditional Medicare with a supplement.
Medicare and Medicare Advantage impact on the rehabilitation experience.
The financial benefits of Medicare Advantage are clear. But the plans can cost seniors crucial rehabilitation time after surgery or a serious illness when compared to Traditional Medicare with individually selected supplements.
The waiting game: pre-certification and approval delays.
Here’s a scenario that plays out almost daily: Someone has surgery at the hospital. Their doctor says they’re medically ready to move to a rehabilitation facility. The hospital is ready to discharge them. The rehabilitation facility has a bed waiting. Everyone is ready.
Except the insurance company.
With Medicare Advantage plans, there’s a pre-certification and approval process that has to happen before a patient can be transferred to rehabilitation. This process typically takes two to three days—sometimes longer.
Ryan Levengood, executive director at The Restoracy, sees this constantly. “I met with a patient recently who kept asking, ‘What’s happening? I’m ready to come. I’ve been ready since Saturday and now it’s Tuesday.’ They don’t understand why they’re still sitting in a hospital bed when they could be starting therapy.”
Ryan adds, with Traditional Medicare, when a patient meets the requirements for rehabilitation care, there’s no waiting for pre-certification. When the patient is ready and the facility is ready, they transfer.
This isn’t just about paperwork. Every day someone waits in a hospital bed instead of starting rehabilitation, their recovery is delayed. They’re not moving, not doing therapy, not taking that crucial first step toward getting home. For older adults, this waiting period can increase the risk of hospital-acquired infections, muscle weakness from bed rest, and declining mental health from the uncertainty of their situation.
Shortened treatment windows.
Medicare Part A covers up to 100 days in a skilled nursing facility if you meet certain conditions, including having a three-day inpatient hospital stay and needing daily skilled care–which includes rehabilitation therapies. Realistically, not everyone uses all 100 days, and how long seniors can stay often depends on their insurance type.
With Traditional Medicare, the average rehabilitation stay is 19 to 20 days. Patients receive the therapy they need, make steady progress, and typically transition home or to the next level of care when they’re ready.
With Medicare Advantage, the average stay is about 10 to 13 days before insurance companies start denying continued coverage. That’s nearly a week less of rehabilitation time on top of waiting longer to start necessary therapies.
That week matters. Ryan puts it plainly: “You get cut open, they’re doing open heart surgery—you’re not just hopping right back to a gym. It’s substantially different when you’re dealing with an 85-year-old, a 90-year-old, a 95-year-old who needs to get back to assisted living and walk hundreds of feet to get to a dining room.”
The appeals process: when insurance says “No.”
All too often, families hear that insurance is denying continued rehabilitation care just as their loved one is making real progress. But because they’ve shown improvement, the insurance company argues they no longer need skilled rehabilitation.
What follows is an appeals process. The rehabilitation facility gathers documentation from therapists and nurses, writes detailed reports explaining why continued therapy is medically necessary, and submits appeals. This has to happen every time insurance denies coverage, which can be multiple times during a single stay.
“Nine out of ten families will say, ‘Okay, what happens when insurance says I no longer meet criteria?'” Ryan shares. “They’re in a panic because their family member just had a stroke or a heart attack. And we’re fighting and sending in all this documentation every week, which stresses out the patient and the family.”
The emotional toll is enormous. Families are already dealing with the stress of a loved one’s medical crisis. Now they’re worried about insurance denials, wondering if they’ll have to pay out of pocket, trying to figure out what comes next if their loved one isn’t ready to go home but insurance won’t cover more skilled care.
When medical situations change.
Perhaps the most challenging scenario happens when a patient’s medical situation changes after rehabilitation certification is complete with the insurance company. Ryan shared a powerful example:“I just had a patient who was admitted for an orthopedic issue—a pretty straightforward joint replacement. Everything was going well, we’d done all the pre-certification paperwork, and then she developed a massive blood clot. She nearly died and ended up in intensive care for three or four weeks.”
Once stabilized enough to start rehabilitation, The Restoracy had to resubmit all of the pre-certification paperwork and adjust for the patient’s increased needs based on her complications. The insurance company kept insisting on a shorter time period based on the initial orthopedic diagnosis, ignoring the severity of the patient’s cardiac issues and de-conditioning after weeks of intensive care.
The family hired an attorney to fight the insurance company, but not everyone has the time and resources or knows that this is an option. After more appeals and denials, the patient received some of the additional rehabilitation needed, still ultimately being denied the full spectrum of care for the best rehabilitation results.
This story illustrates a crucial point: insurance decisions are often made by someone in an office who doesn’t know the patient, hasn’t seen their progress, and may be focused on the initial diagnosis rather than the complete picture of what that person needs to recover.
All of this assumes that your preferred facility even takes Medicare Advantage.
All across the United States rehabilitation facilities will accept patients with Traditional Medicare. This is not the same case for Medicare Advantage, which is administered by private insurance companies and reimburses skilled care and rehabilitation facilities at lower rates. This ultimately leaves some patients with extended hospital stays as they try to find facilities that both accept their coverage and will provide the level of care necessary–some end up paying many thousands more out of pocket to access top tier facilities, losing the only true advantage Medicare Advantage plans offer–cost savings via lower premiums.
Making an informed choice.
Deciding on senior health insurance options is deeply personal. Medicare Advantage isn’t wrong for everyone and it helps many more people with limited means access medical care. For many people, the lower monthly premiums and predictable costs make it the right choice. If you’re healthy and don’t anticipate needing post-acute care, Medicare Advantage might work well for you.
Build your understanding of premiums, care available, and the process as you determine the type of insurance for yourself or a senior loved one.
Questions to ask when exploring Medicare options.
Before choosing between Traditional Medicare and Medicare Advantage, consider these questions:
About your health and needs:
- Do you have chronic conditions that might require hospitalization?
- Have you had surgeries or medical events that required rehabilitation in the past?
- Are you at higher risk for falls, strokes, or cardiac events?
- Do you have family support if you need to navigate insurance appeals?
About your insurance options:
When talking to an insurance broker or agent, ask:
- What’s the approval process for post-acute rehabilitation care?
- How long does pre-certification typically take?
- What’s the average length of stay approved for rehabilitation?
- What happens if I need more time than initially approved—what’s the appeals process?
- Can you give me examples of how this works in real situations?
About your financial situation:
- Can you afford the higher monthly premiums of Traditional Medicare plus a supplement?
- Would you have resources to pay privately for rehabilitation if insurance coverage ends?
- Do you have savings that could cover unexpected gaps in coverage?
Resources to learn more.
Making Medicare decisions feels overwhelming for many seniors and their families. There are free resources available to help:
Medicare.gov (https://www.medicare.gov) – The official U.S. government site for Medicare has comprehensive information about all your coverage options, costs, and how to compare plans.
State Health Insurance Assistance Program (SHIP) (https://www.shiphelp.org/) – Every state has a SHIP program that provides free, unbiased counseling about Medicare options. In Indiana, you can reach SHIP at (800) 452-4800 (https://www.in.gov/ship/). Trained counselors can help you understand your options, compare plans, and make the choice that’s right for your situation. This service is completely free.
1-800-MEDICARE (1-800-633-4227) – Call 24/7 to get help understanding your options. TTY users can call 1-877-486-2048.
The bottom line.
The best insurance choice is the one that works for you both financially and when you actually need care. Traditional Medicare with a supplement typically costs more each month, but it generally provides smoother access to rehabilitation care with fewer approval delays and longer average stays. Medicare Advantage usually costs less each month and provides predictable expenses, but it may involve pre-certification delays, shorter rehabilitation stays, and potential appeals processes if you need post-acute care.
Neither choice is inherently right or wrong. The right choice is the informed choice—one that considers your health, your finances, and your priorities.