Does Medicare Cover Rehabilitation for Stroke Survivors?
This article was updated on: 09/07/2017
What are the effects of a stroke?
According to the Centers for Disease Control and Prevention (CDC), a stroke occurs when something blocks the blood supply to a part of brain or when a blood vessel in the brain bursts. The CDC states that someone in the U.S. has a stroke every 40 seconds. The good news is, according to the National Institute of Health (NIH), that two-thirds of these individuals survive. However strokes are also a major cause of serious disability and reduced mobility in survivors. According to the American Stroke Association, a stroke can cause paralysis of the left and ride sides of the body, vision problems and speech and language problems. Survivors of strokes and brain injuries may need intensive rehabilitation programs to regain some of their daily functions.
What can rehabilitation do for stroke survivors?
The National Institute of Health states that while rehabilitation cannot reverse brain damage, it can substantially help stroke survivors achieve the best long-term outcome for their lives. Paralysis is one of the most common disabilities following a stroke. Rehabilitation may teach stroke survivors how to walk, bathe, use the toilet, and dress making the most of their residual abilities. They also will need to relearn how to speak with compromised language abilities. The success of rehabilitation, according to the National Institute of Health, is repeated practice.
Does Medicare cover rehabilitation for stroke survivors?
According to the NIH, rehabilitation for a stroke can occur as soon as 24 hours after the stroke’s occurrence. Original Medicare Part A and Part B may help cover the costs of inpatient, outpatient, and even at-home rehabilitation services. Benefits may extend to services provided by doctors, various kinds of therapists, nurses, and other medical professionals who are licensed to offer this kind of care. For example, if you are a patient in a skilled nursing facility (SNF) Medicare may cover physical and occupational therapy and speech-language pathology services.
Medicare Part B may also cover medically necessary physical and occupational therapy and speech-language pathology services on an out-patient basis. There are usually therapy cap limits on rehabilitation services, meaning there is a limit each year that Medicare will cover, although in certain cases there are exceptions to these caps. In order to qualify for a cap exception you must have a therapist establish your need for medically necessary services and indicate that your outpatient services are medically reasonable. Your costs for rehabilitation services such as physical therapy, occupational therapy, and speech-language pathology under Medicare are typically 20% of the Medicare-approved amount. Your Part B deductible applies.
Medicare Advantage plans offer beneficiaries another way to receive their Medicare benefits and may be a good option for stroke survivors in rehabilitation. Medicare Advantage plans must cover Part A and Part B benefits, with the exception of hospice care, which Part A still covers. Medicare Advantage, which is offered by private insurance companies may also cover vision, dental, and prescription drug coverage.
Medicare.gov has a search tool which allows you to find inpatient rehabilitation facilities in your zip code. The tool lets you compare facilities on factors of quality of patient care such as rate of new or worsened pressure ulcers, catheter-associated urinary tract infections and rate of unplanned a readmission after discharge.
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