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Medicare Coverage for Stroke Victims & Rehabilitation


Medicare coverage is available for stroke victims. With a stroke comes plenty of side effects. Medicare coverage includes both inpatient and outpatient care. Medicare can cover rehab services to help you regain normalcy in life. Also, Medicare covers any Durable Medical Equipment you may need to use because of your stroke.

What Does Medicare Pay for After a Stroke?

Part A will cover any inpatient rehab you may need after your stroke. Your doctor must deem that rehabilitation is medically necessary for treating you following the stroke. There are deductibles, coinsurances, and limits to the number of days you can spend in the hospital when Medicare is your only insurance.

Will Medicare Pay for Skilled Nursing Facility for Stroke Patients?

Medicare will cover Skilled Nursing Care that you might need following your stroke. To qualify, you’ll need to meet Skilled Nursing Facility requirements just like any other patient. Costs for SNF care are the same for stroke victims as for anyone else in need of those services.

Will Medicare Pay for Long-Term Care Facilities for Stroke Patients?

Your doctor may decide that you need long-term care following your stroke if your health takes a turn for the worse. Medicare won’t cover Long-Term Care if it’s the only kind of care you need. Medicare won’t usually cover this service because care consists of bathing, feeding, and using the restroom. They’re not considered medical care services.

Will Medicare Cover Walkers for Stroke Patients?

As with other pieces of medical equipment, Part B will cover necessary walkers. Your walker will need a prescription from your doctor. The most popular kinds of walkers following a stroke are 2-wheel and 4-wheel walkers, Medicare will cover a portion of the cost for either.

Does Medicare Advantage Cover Stroke Patients?

There are Medicare Advantage Chronic Care Special Needs Plans specifically for Stroke survivors. If one of these plans is available in your area, this could be an option for you if you don’t qualify for a Medigap plan. Before choosing to enroll in a Medicare Advantage plan, there are a few things to consider; are your doctors, hospitals, and specialists in-network? Does the policy cover your pharmacy and drugs? And, just how much will a catastrophic event cost?

While some coverage is better than none, if you can fit Medigap into your budget, it’s highly recommended.

Will Medicare Supplement Plans Cover Stroke Patients?

Yes, Medicare Supplements will always cover the same thing services Medicare does. Therefore, a supplement plan will cover most, or all, of your cost-sharing after Medicare pays their portion.

What are the costs of stroke rehabilitation with Medicare?

The average cost of stroke rehabilitation comes to over $17,000 within your first year. Medications can cost over $5,000, while rehab will likely cost you more than $11,000. With high prices like these, you’ll want to be sure that you have adequate insurance coverage. Medicare Supplement and Advantage policies are a great alternative to high out-of-pocket expenses.

FAQs

Will Medicare Cover Stroke Medications?
You can buy Part D or a Medicare Advantage policy to help you with drug costs. Before enrolling in a plan, it’s your responsibility to ensure your medications on the plan formulary.
How long does Medicare pay for rehab after a stroke?
Medicare covers up to 90 days of inpatient rehab. You’ll need to meet your Part A deductible and cover coinsurance costs. After your 90 days, you’ll start using your lifetime reserve days.
How many outpatient occupational therapy sessions does Medicare allow post-stroke?
There is no cap on how many therapy sessions you can get following your stroke. But your doctor needs to prove that inpatient therapy sessions are necessary for you. Part B will cover physical therapy and occupational therapy treatments.
Does Medicare Pay for Physical Therapy After a Stroke?
Part B will cover physical therapy if a doctor says it’s medically necessary.

How Stroke Patients Can Get Medicare Coverage

Medigap plans can help reduce medical costs. Let our team of Medicare experts find the best rates and supplement plans for you. Call our licensed agents today for a free quote! Always remember, some insurance is better than no coverage. If you can’t call, fill out an online rate form to see the rates in your area today!

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

18 thoughts on “Medicare Coverage for Stroke Victims & Rehabilitation

  1. My husband had a serious stroke on May 26 with left-sided weakness. Sr Advantage /Medicare gave him 30 days of rehab and sent him home with outpatient Ot-PT and speech. He still needs more intensive rehab to learn to transfer for a better ability to live at home. It’s difficult to find such a facility even as we are able to pay. We’ve been advised he needs daily therapy at least 3 hours /day.

    1. Hi Anne. First, I’m sorry to hear your husband had a stroke. Are you looking to get him more intensive rehab at an inpatient or outpatient facility?

      1. Yes. Our therapists say he needs equipment like a standing frame to help him learn to stand so he can be taught to transfer from bed to chair with one person. Otherwise he remains a total dead weight.
        Thank you

      2. Anne, it sounds like you’re looking for information on Durable Medical Equipment. Part B will cover DME 80%. However, since your husband enrolled in a Medicare Advantage plan, it’s up to the carrier how much they will cover. You’ll have to reach out to them directly to find out what your out-of-pocket costs will be.

  2. Hi Lindsay,
    My husband had a major stroke in June and is in a skilled nursing facility however, his insurance has recently denied him for continued care and now I’m being billed $578/ day. What are my recourse to have his insurance pay for his services.

    1. Hi Justine! Do you know what parts of Medicare he is enrolled in? Original Medicare only covers the first 20 days at a skilled nursing facility. After day 21, you’ll pay coinsurance for each day. After day 100, you pay 100% for each day. I would reach out to your local Medicaid office to see was resources are available in your state.

  3. My Aunt had a stroke and has transferred to skilled nursing rehab. She has been there three days with no therapy. Is there a guideline on therapy? How many hours or days per week? In Acute rehab she had it 6 days a week and at least 3 hours per day.

    1. Hi Kathy! This is out of our expertise. You would want to contact her PCP or the doctor at the facility directly to get this resolved.

  4. My Mother had a stroke at age 72 she has Humana Medicare advantage plan. The case worker is telling us that she only receives 7 days of rehabilitation and we can request an additional 7 days after that, but then we’re on our own. When my day had his stroke he had 90 days of rehab. Can Humana limit the care they provide. The doctors say she may need 2 months of rehab for recovery.

    1. Hi Walter! First, I’m sorry your mother has suffered a stroke. Your father had more than likely qualified for Skilled Nursing Care. If your mother qualifies, she would be transferred to a Skilled Nursing Facility. Medicare Advantage plans work differently than Medicare, but she should still qualify. She would receive 100% coverage the first 20 days, then for days 21-100, she would have a copay. After 100 days, she would have to pay out of pocket 100%. I would reach out to Humana and ask them about Skilled Nursing Care after a stroke.

  5. Hi Lindsay,
    I was hoping you would be able to shed light to something that was surprising related to patient care, post acute stay for a stroke. A Health System VP of Care Management suggested if there is an opportunity to send a patient home, the patient should go home to continue to recovery with the appropriate services.
    Are there new guidelines and incentives from CMS, to discharge patients to home if care plan protocols permit, rather going to a more costly SNF, rehab?
    Thanks
    Al

  6. Hi Lindsay. My 98 year old mother suffered a stroke on Saturday. The hospital is pushing hard for us to move mom into a rehab facility. With mom’s dementia, and their “no visit” rules, we’re hoping we could take mom home and bring in the needed care givers. Will Medicare pay for the full time care she requires? Thank you so much. I believe she has Part B. Kevin

    1. Hi Kevin. I’m so sorry to hear about your mother. Yes, Medicare will cover at-home caregiving on a short term basis. The doctor must order rehab therapy visits for treatment and care must be from a certified Home Health Agency through Medicare. I hope this helps!

  7. My husband just had a stroke and has no income. Who can I talk to? How can I find out about if he is eligible? And how do I go about applying for medicare coverage?

    1. Hi Nanette. I’m so sorry to hear about your husband. He is eligible for Medicare as long as he’s at least 65 years old or after 24 months of collecting disability benefits. You can apply for Medicare online, over the phone, or in person. Part A is premium-free as long as your husband paid into enough quarters when working, which is usually the case. Part B comes with a monthly premium. I would reach out to your state’s Medicaid office to see how they can help due to him having no income. Medicaid will help pay Medicare premiums for those considered low-income.

  8. What are the costs for hospitalization for stroke patients? Do hospitals admit patients who enter the hospital through the ER? Does Medicare cover costs for patients admitted by the hospital for “observation” even though they have been diagnosed with a minor stroke?

    1. Hi Mike! There is no set amount a hospital will charge for stroke patients. It depends on the treatment the doctor at the time feels is necessary. Yes, hospitals will admit patients that were admitted into the ER. Yes, Medicare will cover the costs regardless if you’re admitted as an inpatient, outpatient, or under observation after being diagnosed with a minor stroke.

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