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Understanding Medicare Coverage for Stroke Survivors

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World Stroke Day is Friday, October 29, 2021. This is the day to focus on stroke prevention, and on healthcare options for individuals who have survived a stroke. Major side effects of stroke include decreased mobility, problems with hearing, vision, or balance, and paralysis. 

What Does Medicare Cover for Stroke Survivors?

Every year, more than half a million people over the age of 65 suffer a stroke, as reported on Medicare.gov. Fortunately, Medicare covers medical and rehabilitation services delivered in a hospital or skilled nursing facility. It will also help pay for outpatient physical therapy and occupational therapy if deemed medically necessary. In addition, Medicare covers any durable medical equipment required because of a stroke. This may include canes, walkers, wheelchairs, or lifts. 

How Does Medicare Payment Work After a Stroke?

Hospitalization with a stroke is covered under Medicare Part A. Your care must be deemed medically necessary. This means it must be a procedure, test, or service required by a doctor following diagnosis. 

There is a deductible to meet ($1,484 in 2021). There is no coinsurance per day for the first 60 days in the hospital. However, on days 61 through 90, coinsurance per day is $352, and it goes up to $704 for days 91 and beyond. 

Outpatient rehabilitation, such as physical therapy, is covered by Medicare Part B. The Part B deductible in 2021 is $203. After the deductible is met, Medicare pays 80% and you pay 20% of the cost of covered treatment. There is no cap on out-of-pocket costs with Original Medicare. 

Will Medicare Cover Long-Term Care After a Stroke?

If a person’s health worsens significantly after a stroke, the doctor may decide long-term care is needed. Medicare will not cover long-term care, as it involves assistance with feeding, bathing, etc., and these are not medical services. 

What Are the Costs of Stroke Rehabilitation?

In a 2011 study published on PubMed.gov, researchers found that the average cost of stroke rehabilitation, including medications, in the first year after being discharged from the hospital was $17,081. This breaks down to $11,689 for rehabilitation services and $5,392 for medications. 

How Can You Reduce Out-of-Pocket Costs With Medicare After a Stroke?

There is no annual limit on out-of-pocket expenses with Original Medicare. The higher your healthcare expenses, the more you pay out of pocket. A Medigap plan can help reduce the burden of Medicare out-of-pocket costs after a stroke. These plans are only available to individuals enrolled in Original Medicare. A Medigap plan can help cover deductibles, copayments, and coinsurance you would otherwise have to cover yourself. 

To purchase a Medigap plan, you pay a private insurance company a monthly premium, in addition to your Medicare Part B premiums. These plans cover only one person. If you and your spouse both need Medigap coverage, you will need to purchase two separate policies. Medigap policies are guaranteed to be renewable – as long as you pay your premiums, the insurance company cannot cancel you. 

Our agent can help you find a Medigap plan to suit your needs, for additional coverage in case of a stroke or other health emergency. 

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