Medicare coverage is available for stroke victims in hospitalization and rehabilitation. It also covers wheelchairs, walkers, lifts and other durable medical equipment your doctor might prescribe.
Medicare prescription drug plans cover medications after a stroke. As with all Medicare coverage, you may be responsible for deductibles and copays, depending on the type of coverage you have and the services you need.
The Cause and Effect of Stokes
A stroke happens when the flow of blood to your brain is cut off. Without oxygen, brain cells begin to die, and the stroke sufferer loses the bodily functions controlled by those brain cells. Almost 800,000 people suffer strokes each year.
People with high blood pressure, high cholesterol, diabetes or a heart condition known as atrial fibrillation, or AFib, have a higher risk of stroke. Lifestyle factors such as physical activity level, smoking, and alcohol consumption can also affect your risk of a stroke.
Your stroke risk increases as you get older. Strokes are the number one cause of adult disabilities and the fifth leading cause of death in the U.S.
A stroke can affect you in several ways, depending on how severe it is and what part of the brain it impacts. Small strokes may cause only minor and temporary issues, but a major stroke can leave you with permanent paralysis or unable to speak.
About two-thirds of stroke survivors have a disability.
Medicare Part A Coverage for Stroke Victims
Hospitalization in a regular hospital or inpatient rehabilitation hospital is covered by Part A. However, Part A has a deductible of $1364 for 2019. Medicare pays 80% after the deductible.
This includes the cost of a semi-private room, nursing, drugs while in the hospital, and any other services or supplies. For the 61st through 90th day in the hospital, you must pay coinsurance for each day you remain in the hospital. The coinsurance amount for 2019 is $341 per day.
If you suffer a severe stroke, you may need to stay in a rehabilitation hospital for more than 90 days. In that case, you can continue to receive Medicare coverage by using “lifetime reserve days.”
Everyone has 60 lifetime reserve days for after regular Medicare coverage has run out. In 2019, you pay a coinsurance of $682 for each lifetime reserve day you use.
After you use all your lifetime reserve days, you’re responsible for the cost of any additional days you spend in the hospital.
Medicare Coverage for Skilled Nursing Facility Rehabilitation
If you have a relatively minor stroke, you might receive physical and occupational therapy and other services in a skilled nursing facility. Medicare will cover a stay in a skilled nursing facility, but the rules are a little different than for a rehabilitation hospital.
You must have been an inpatient at a hospital for at least three days before going to the skilled nursing facility.
Medicare will cover the full cost of days 1-20. For days 21-100, you are responsible for coinsurance of $170.50 per day for 2019. Starting on day 101, you must pay all costs.
Medicare and Durable Medical Equipment for Stroke Survivors
If a stroke affects your mobility, you may need a wheelchair, cane, walker, lift or other assistive equipment. Many of these assistive devices are considered “durable medical equipment” under Medicare’s rules. If your doctor prescribes durable medical equipment, Part B covers 80 percent of the cost.
Medicare Coverage for Stroke Medications
Prescription drug coverage isn’t part of Original Medicare; however, you can get prescription coverage by buying a standalone Part D prescription plan or by enrolling in a Medicare Advantage plan including prescriptions. Part D will help with drug coverage for stroke victims.
Every prescription plan is a little different, and the exact amount you will pay for your medications depends on your plan, the pharmacy you use, and the medication your doctor has prescribed.
Maximizing Coverage with a Medigap Plan
A Medigap plan can prevent financial disaster if you have a long hospitalization after a stroke. There are 10 Medigap plans available in most states; all pay the Part A coinsurance, plus an additional 365 days in the hospital after Medicare’s benefits end. Most plans also pay all or part of the Part A deductible. Some plans pay all or part of the coinsurance for skilled nursing facility care.
Outpatient doctor visits, physical therapy, and durable medical equipment are covered by Part B. With Part B alone, you are responsible for 20 percent of the cost. A Medicare Supplement plan will pay all or part of the 20% Medicare doesn’t cover.
We can quickly search the top insurance companies in your area to find the most competitive rates on supplement coverage. We will answer your questions and help you compare plans. To get started with your free quote, call us or fill out an online rate form.