Medicare Coverage for Stroke: Acute Care, Rehabilitation, and Recovery

Stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States. For Medicare beneficiaries, understanding coverage for stroke treatment and rehabilitation can mean the difference between a full recovery and permanent disability.

Time is critical in stroke treatment -- "time is brain." Medicare covers emergency stroke care immediately.

Emergency department: Covered under Part B (outpatient) or Part A (if admitted as inpatient).

tPA (clot-busting medication): Covered for eligible ischemic stroke patients when administered within the treatment window.

Mechanical thrombectomy: Covered for large vessel occlusion strokes -- a procedure that physically removes the clot.

Inpatient hospital stay: Covered under Part A. You pay the Part A deductible ($1,340 in 2018) for days 1-60.

After the acute hospital stay, many stroke survivors transfer to an Inpatient Rehabilitation Facility for intensive therapy. Medicare covers IRF care when:

• You require intensive rehabilitation (at least 3 hours of therapy per day, 5 days per week)
• You can tolerate and benefit from intensive therapy
• You need physician oversight and 24-hour nursing care
• You had a qualifying inpatient hospital stay

Coverage: Covered under Part A. The IRF stay is subject to the same Part A benefit period rules as the acute hospital stay.

What IRF provides: Physical therapy, occupational therapy, speech-language pathology, recreational therapy, neuropsychology, and medical management -- all under one roof.

If you cannot tolerate the intensity of IRF care, a Skilled Nursing Facility may be appropriate. Medicare covers SNF care after a qualifying 3-day inpatient hospital stay.

Coverage:

• Days 1-20: $0 (after the Part A deductible)
• Days 21-100: $167.50/day coinsurance (2018)
• After day 100: No Medicare coverage

Once you return home, Medicare covers skilled home health services if you are homebound and need skilled care:

• Physical therapy to restore mobility and strength
• Occupational therapy to relearn daily activities
• Speech-language pathology for communication and swallowing problems
• Skilled nursing for wound care, medication management, and monitoring

Coverage is unlimited as long as you remain homebound and need skilled services.

Medicare Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology for ongoing stroke recovery. These services are subject to therapy caps (with exceptions for medically necessary care) and 20% coinsurance.

Therapy caps (2018): $2,010 combined for PT and SLP; $2,010 for OT. Exceptions are available for medically necessary care beyond the cap.

Preventing a second stroke is critical -- recurrence risk is highest in the first 90 days. Medicare Part D covers stroke prevention medications including:

• Antiplatelet agents (aspirin, clopidogrel, aspirin/dipyridamole)
• Anticoagulants for atrial fibrillation (warfarin, newer oral anticoagulants)
• Blood pressure medications
• Statins

Research consistently shows that intensive, early rehabilitation produces the best stroke recovery outcomes. Don't accept less rehabilitation than Medicare covers. If you feel you're being discharged from rehab too soon, you have the right to appeal.

Important: Medicare cannot discharge you from a covered service solely because you've stopped making progress -- as long as you need skilled care to maintain your current level of function, Medicare should continue to cover it.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.