Does Medicare Cover In-Home Care After a Stroke?
Medicare Benefits Solutions
Jan 11, 2023
If you’re eligible for Medicare due to age or disability, medically necessary care is covered by Part A and Part B. Part A may cover inpatient care for a stroke if treatment takes place in a hospital or skilled nursing facility (SNF), or for some skilled care at home. Part B may help cover outpatient rehabilitation care and services.
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Can a Stroke Victim Stay at Home?
Approximately 800,000 Americans suffer from a stroke every year. There are different types of strokes that can leave the patient with varying degrees of short and long-term damage. Those who survive often require post-stroke rehabilitation, according to the National Institute of Neurological Disorders and Stroke (NINDS). If you or a loved one has suffered a stroke, you may be concerned about the costs of care you’ll need at home.
Post-stroke care may include coordinated, interdisciplinary care. According to the American Stroke Association, a care team may include physicians, nurses, occupational therapists, speech/language pathologists, recreation therapists, nutritionists, social workers, and more.
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What Should Stroke Patients Know About Medicare Coverage?
If you qualify for inpatient skilled nursing care or outpatient therapy, coverage is provided only as long as needed to improve your condition. It is a short-term solution. Medicare does not cover custodial care in a private home, nursing home, or assisted living facility. For that reason, some people purchase long-term care insurance.
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What are the Costs of Medicare In-Patient Stroke Rehab?
The cost of inpatient rehabilitation in an SNF, covered under Part A, depends on the level of care you need and the duration. The therapists and medical staff document your progress on a regular basis.
The SNF benefit under Original Medicare is contingent on a preceding three-day minimum hospital stay for a related medical issue. Additionally, Medicare must receive your doctor’s certification that institutional daily skilled care is medically necessary, and the facility has to be Medicare-certified.
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How Many Days Will Medicare Pay for Rehab After Stroke?
Your out-of-pocket expense depends on how many days you stay:
- Day 1 through 20: no coinsurance
- Day 21 through 100: a fixed amount of coinsurance per day (amount changes each year)
- Day 100: patient responsibility for all costs
The coverage is for each benefit period, not per year. A benefit period begins on the first day of admittance to a hospital or SNF and ends after 60 days in a row of no inpatient care since your release. There is no maximum number of benefit periods.
The SNF finance department typically communicates an estimate of patient responsibility based on authorization of services and insurance coverage.
Does Medicare Pay for Home Healthcare After Stroke?
Once you are released from the hospital or rehabilitation facility, you may need Medicare home care temporarily. A stroke can affect regions of your brain that impair your ability to walk, grasp objects, speak or understand. Depending on the extent of brain damage, you may need to re-learn daily living activities like bathing, dressing and transferring out of bed.
Home care with Medicare is a benefit your doctor can authorize if you are homebound and your doctor certifies that you need skilled services. Within the scope of Medicare home care, homebound means that leaving home is prohibitive:
- Without assistive equipment or the help of a caregiver
- Due to your medical condition
- Because it is too challenging
Medicare covers 100% of home health services as long as medically necessary services are ordered by your doctor and delivered by a Medicare-certified home health agency.
What Home Healthcare is Covered by Medicare?
The goal of Medicare home health care services is to improve your quality of life and increase your independence at home.
Home health services may include:
- occupational therapy
- physical therapy
- speech therapy
Occupational therapy (OT) helps you adapt to your physical limitations by showing you how to bathe, dress, prepare meals and transfer out of bed independently. An occupational therapist evaluates your home for safety and can suggest modifications like stair rails, grab bars and devices that make your home environment safer and easier to navigate.
Physical therapy (PT) helps you build back your leg strength, endurance and ability to walk. If you have stairs in your home, a physical therapist can train you to safely climb your stairs again.
A stroke can cause such disabilities as language impairments and problems swallowing. A speech therapist can perform an evaluation and develop a treatment plan to improve these functions. Scheduled visits may include mealtimes to offer tips on swallowing food.
Does Medicare Cover Walkers and DME After a Stroke?
Part B covers durable medical equipment (DME) that you may need after a stroke. During your recovery, you may experience weakness and numbness, and loss of mobility and balance. If medically necessary, your doctor can order items for use in the home, such as a hospital bed, wheelchair, or walker. Your cost is the Part B deductible and 20% coinsurance if you use DME suppliers enrolled in Medicare.
How Can Stroke Patients Get Medicare Coverage?
If you are not yet enrolled in Medicare, you can sign up when you turn 65 regardless of pre-existing health conditions. Your Initial Enrollment Period starts three months before the month you turn 65 and ends three months after the month you turn 65. You may qualify for Medicare under the age of 65 due to certain disabilities.
Once you are enrolled in Part B and 65 years old, you have six months to purchase a Medicare Supplement (Medigap) plan. Please note, you cannot have a Medicare Advantage and Medicare Supplement plan at the same time. To compare plans, you may want to check our plan finder tool.
Does Medicare Advantage Cover Stroke Patients?
You can enroll in a Medicare Advantage (MA) once you’ve enrolled in Part A and Part B. Medicare Advantage (MA) plans cover the same benefits as Original Medicare and may extend additional benefits. For example, some MA plans do not require a three-day hospital stay before admittance to a rehabilitation facility. However, unlike Original Medicare, MA plans generally require or encourage members to use doctors and facilities within the plan’s provider network.
Medicare Coverage for Cardiovascular Stroke Prevention
Conditions that alert doctors to a patient’s risk of a heart attack or stroke include high levels of cholesterol, lipids and triglycerides. Medicare Part B pays for one blood test every five years to look for these markers of cardiovascular disease. To reduce your risk, Part B also covers an annual cardiovascular behavioral therapy visit with your primary care physician. The visit generally entails checking blood pressure, discussing medication options and offering tips for a healthy diet.
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