Everything You Need to Know About Strokes & Medicare Coverage

Did you know that every year more than 795,000 people in the US have a stroke? About 610,000 of these are first or new strokes. About 185,000 strokes (nearly 1 of 4) are in people who have had a previous stroke. It is the life-altering and unpredictable side effects after having a stroke that cost stroke victims the most. 

Let’s talk strokes

According to the MayoClinic, A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.

A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. The good news is that fewer Americans die of stroke now due to effective treatment. Any physical changes after a stroke will depend on which part of your brain was damaged and by how much.

Changes in physical experience can include:

  • Difficulty with gripping or holding things
  • Fatigue or tiredness can be caused by physical changes or medication, but also mood changes, depression, anxiety, or difficulty sleeping
  • Incontinence- many types of incontinence can occur, but it can be caused by medication, muscle weakness, changes in sensations, thinking, and memory
  • Pain can be caused by actual or potential damage to your tissues (nociceptive pain) or by damage to your nerves that then send incorrect messages to your brain (neuropathic pain)
  • Restricted ability to perform physical activities or exercise
  • Swallowing issues
  • Vision problems
  • Weakness or paralysis of limbs on one side of the body.

Medicare has you covered

Once deemed medically necessary by your doctor, you should be covered. Medicare coverage includes both inpatient and outpatient care, which means that rehab services and Durable Medical Equipment (DME) are covered to help you regain normalcy in life. 

Part A is responsible for covering any and all inpatient rehab you may need after your stroke. If Medicare is your only source of insurance, you might have additional deductibles, coinsurances, and limits to the number of days you can spend in the hospital. Part D or the right Medicare Advantage Plan can help you with drug costs. Before enrolling in a plan, be sure to understand if your medications are on the plan formulary.

Will Medicare Pay for Skilled Nursing Facility for Stroke Patients?

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

Will Medicare Supplement Plans Cover Stroke Patients?

Yes, Medicare Supplement Plans match Medicare coverage. This means that an additional supplement plan will cover most, or all, of your cost-sharing after Medicare pays their portion.

Fact: 8 out of 10 Medicare Supplement plans will cover the skilled nursing coinsurance.

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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 will not cover Long-Term Care if it’s the only kind of care you require. This is because Medicare does not cover services not deemed medically necessary, such as bathing, feeding, and using the restroom. They’re not considered medical care services.

Does Medicare Advantage Cover Stroke Patients?

There are Medicare Advantage Chronic Care Special Needs Plans specifically for Stroke survivors. 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?

What is the average cost of stroke rehabilitation with Medicare?

The average cost of stroke rehabilitation is about $17,000 within your first year following the stroke. Medications can cost over $5,000 and rehab can add up to 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.

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