Does Medicare Cover Rehab for Stroke Recovery?August 7, 2019
Strokes are fatal in 17% of cases and are the fifth leading cause of death in the United States. For the remaining 73%, stroke recovery is needed to reduce brain injury, but it can cost an average of $17,000 in the first year! It’s important to understand the role of Medicare and how a Medicare Supplement plan can help you save on costs.
Medicare Coverage for Stroke Victims
An inpatient rehabilitation facility requires you to participate in three hours of therapy every day. If you are unable to participate in three hours of care per day, you can move into a skilled nursing facility with a rehab program.
Choosing the right stroke rehabilitation facility is crucial for recovery. Once you are released from the hospital, your options include an inpatient rehabilitation facility, a skilled nursing facility, or a long-term care hospital. Depending on the severity of your stoke, you may be able to return home and utilize home healthcare or outpatient therapy.
Here are some questions to keep in mind when choosing a facility:
- How many patients does the facility have?
- How do they assure high-quality care?
- What actions are taken to prevent falls?
- How do they measure progress?
- What therapy programs are available?
- How do they transport you when needed?
- What certifications does the facility have?
- Are they accredited through the Commission on the Accreditation of Rehabilitation Facilities?
- What medical services are available?
- How intense is the recovery program?
How much does Medicare pay for stroke rehab?
Medicare will pay for an inpatient rehabilitation facility the same way it covers hospital stays. This means you are fully covered for 60 days. After 60 days, you will pay $341/day until you reach 90 days, and then $682/day until you reach 150 days. If your care extends past 150 days, you will have to pay the full amount, but your cycle resets after you spend 60 days at home.
Your hospital coverage includes a semi-private room, hospital meals, nursing services, intensive care, drugs and medical supplies used during your stay, lab tests and x-rays, operation and recovery services, some blood transfusions, rehabilitation, and symptom management.
It does NOT include non-medically necessary amenities like completely private hospital rooms, private nurses, and personal care items that hospitals may provide (shower supplies, TV, etc.). To learn more about Medicare Part A coverage, click here.
Home Health Care:
If you are discharged to your home, Medicare will cover up to 60 days for home health services. Medicare Part B will cover your outpatient therapy (physical, speech-language pathology, occupational) at 80%; you will be responsible for 20%.
How many days will Medicare pay for a rehab facility?
Medicare has a 100-day rule for skilled nursing coverage, meaning that Part A will cover 100 days in a skilled nursing facility. The first 20 days are covered completely, but the remaining days (21-100) require coinsurance of $170.50/day.
When you are hospitalized for a stroke, you have 30 days to enter the skilled nursing facility. Like hospital stays, benefit periods last for 60 days. If you leave the facility and are back home for at least 60 days, the next time you enter a facility your “day count” will reset to 0.
The goal of stroke rehabilitation is to recover your body’s functions as much as possible. The process includes exercises to improve actions like talking, walking, and using the restroom.
In some cases, full recovery may be difficult. In this case, your therapist will teach you compensatory strategies. For example, if you lose the ability to use your arm, your therapist will teach you other ways to use the restroom, get into bed, and cook your own meals.
How long does it take for a person to recover from a stroke?
The average stroke patient will see the most improvement in the first three months. However, recovery time will vary on a case-by-case basis depending on the stroke severity. If your brain stem was damaged during the stroke, your recovery time could be a year or longer.
What percentage of stroke patients make a full recovery?
The National Stroke Association estimates that roughly 10% of stroke patients make a complete recovery. This may sound like a small percentage, but don’t let that discourage you! 25% recover almost completely excluding minor impairments (like minimal vision or memory loss). Another 40% will recover but require special short-term care.
Can paralysis from a stroke be reversed?
When you have a stroke, the lack of oxygen and blood cells to your brain can cause damage to millions of brain cells, which can lead to paralysis. This damage is irreversible if the cells are killed, but damaged cells can resume function over time.
Plus, scientists at the Pacific Neuroscience Institute are researching ways to reverse the effects of a stroke by transplanting stem cells and using them as a source for brain cell regeneration. This research will continue, but for now, stroke rehabilitation is the best method to regain independence and recover several of your body’s functions.
How soon after a stroke can you start rehab?
Stroke recovery starts as soon as you are stable. This is typically 24 to 48 hours after a stroke. The first stage of recovery typically takes place in the hospital, but this is dependent on your unique circumstances. After you are discharged from the hospital, your doctors, nurses, and family can help you choose a suitable living arrangement based on your needs.
Benefits of Medicare Supplements
The costs for stroke recovery can add up quickly, and these costs should not disrupt your rehabilitation plan. A Medicare Supplement plan can help cover your copayments, coinsurance, and deductibles. There are 10 plan options (Plan A, B, C, D, F, G, K, L, M, and N). The costs will vary per plan and on which state and county you live in.
Plan F is the most popular Medicare Supplement plan. If you do not have Plan F but you would like to, you can lock yourself in by enrolling NOW. You must enroll before January 1, 2020, to receive Plan F coverage. If you miss this deadline, there’s good news!
Plan G is almost identical to Plan F! The only difference is that Plan G does not cover the Part B deductible (which is less than $200 for most people). In reality, by switching to Plan G you will not be losing much at all. However, keep in mind that you can still keep your Plan F after January 1, 2020, if you enroll in 2019.
If you are interested in exploring Medicare Supplements or have any questions regarding your current coverage, contact us! We have licensed agents across 38 states who are dedicated to making sure you are enrolled in the plan that best fits your needs and budget.
If you are looking for coverage beyond Original Medicare, our agents can help you select a Medicare Advantage (MA) plan instead. Many MA plans offer hearing, dental, and vision coverage, and some even offer group fitness classes like SilverSneakers®. Call us at 844-431-1832 or fill out this form to get in contact with an agent.
This post was originally published on March 7, 2019, by Kelsey Davis and was updated on August 7, 2019, by Troy Frink.