The recovery process after a stroke can be a long journey, especially for those patients experiencing significant side effects. Many stroke patients find they have to deal with issues like paralysis, vision or hearing problems and difficulty with mobility or balance during their recovery period. Thankfully, Medicare coverage can help stroke patients get on a solid road to recovery and rehabilitation. Here's what you need to know about Medicare coverage for strokes:
What Original Medicare Covers for Stroke Recovery
Medicare beneficiaries who are signed up for Medicare Parts A and B — traditionally known together as "Original Medicare" — receive some coverage for stroke recovery and rehabilitation. Specifically, the Medicare program will pay for the following:
- Inpatient rehabilitation: If your doctor deems it necessary for you to receive rehabilitation care at an inpatient facility, Medicare will cover your first 60 days in full, minus your deductible (which is set at $1,556, as of 2022). After 60 days, you will have to pay a $389 coinsurance amount per day until you have reached 90 days in the facility. If you must stay past 90 days, you will have to pay $778 in coinsurance per day, up until 150 days in the facility. After that point, you will have to pay all out-of-pocket costs.
- Skilled nursing care: If you have had a qualifying hospital stay and your doctor deems it necessary for you to receive skilled nursing care within a facility, Medicare will fully cover the costs of your care in the facility for the first 20 days. Days 21 through 100 will require you to pay $194.50 in coinsurance per day, as of 2022. Any further time needed in the skilled nursing facility will be charged to you out-of-pocket.
- Walkers: If you are prescribed a walker as a mobility aid after a stroke, Medicare will cover a portion of the cost. You must have a prescription, however, for Medicare coverage to kick in.
- Outpatient physical and occupational therapy: If your doctor deems either physical or occupational therapy necessary, Medicare will cover 80% of the cost, while you will have to pay 20% of the Medicare-approved cost as a coinsurance amount.
Medicare Coverage Gaps
There are some important stroke recovery options that Original Medicare does not cover. Specifically, if you need long-term care, which is defined as help with non-medical services like bathing, eating or using the bathroom, Medicare will not pay for it. In addition, if your recovery and rehabilitation takes longer than the duration covered by Medicare, then you will be on the hook for the additional time necessary to meet your health goals.
The average cost of stroke recovery and rehabilitation is about $17,000 within your first year. This is why it's important for Medicare beneficiaries to understand their options. Though Original Medicare does not provide complete coverage of your stroke recovery costs, Medicare Advantage plans may be able to help you cover those costs and spend less money out-of-pocket.
What Medicare Advantage Plans Cover for Stroke Recovery
Medicare Advantage offers specific special needs plans (SNPs) for patients who need help paying for specialized care. There are some Chronic Condition SNPs (C-SNP) made for stroke patients that will help pay for the costs of recovery and rehabilitation. Medicare Advantage plans also include Institutional SNPs (I-SNPs) for those beneficiaries who live in an institution like a nursing home or long-term rehabilitation center. These plans can potentially help stroke victims pay for a long stay in such an institution.
Having a special needs Medicare Advantage plan can ease the financial burden of stroke recovery and rehabilitation costs. You can enroll at any time, provided a Medicare Advantage SNP is available in your area.
How to Get the Best Medicare Coverage for Strokes
Though Original Medicare may help with some of the costs of stroke recovery and rehabilitation, you can still expect to be paying quite a bit out-of-pocket to get back to your previous levels of health and mobility. Enrolling in a Medicare Advantage special needs plan, even after you have suffered a stroke, can be a smart way to make sure your recovery costs are covered. With an SNP in place, you can focus your attention on getting better.