Medicare Coverage for Stroke Prevention and Rehab
Original Medicare will help pay for the costs associated with preventing a stroke as well as treatment and rehabilitation if you have a stroke. Medicare Part D prescription drug plans or Medicare Advantage plans may pay for a portion of the prescription medications you need after having a stroke.
What Does Medicare Cover for Stroke Patients?
Original Medicare — Medicare Part A and Part B — can cover some of the costs associated with preventing, treating and recovering from a stroke. However, you may have to pay out-of-pocket costs for some of the services.
- Medicare Part A hospital insurance will cover a large portion of the cost if you have to be hospitalized. You will need to pay a deductible ($1,484 in 2021) and will have a coinsurance payment for each day you are hospitalized beyond 60 days.
- Inpatient rehabilitation care
- If your doctor certifies your care is medically necessary, Medicare Part A covers inpatient rehabilitation care at an inpatient rehab facility, acute care rehabilitation center or rehabilitation hospital. Your out-of-pocket costs for your deductible and coinsurance are the same as if you were hospitalized.
- Occupational therapy
- Medicare Part B medical insurance covers outpatient occupational therapy if it is medically necessary. Occupational therapy focuses on rehabilitating you to perform activities in your daily life such as eating, bathing and dressing yourself. You are responsible for the Medicare Part B deductible ($203 in 2021) and 20 percent of the Medicare-approved cost of occupational therapy services.
- Physical therapy
- Medicare Part B covers medically necessary outpatient physical therapy. Physical therapy focuses on improving your mobility and increasing your range of movement. Medicare pays 80 percent of the approved cost of physical therapy after you pay your Part B deductible. You are responsible for 20 percent of the Medicare-approved amount.
- Preventive services
- Preventive and screening services that detect and prevent illness are covered by Medicare Part B. Preventive services include screenings for risk factors such as diabetes, heart disease and obesity, as well as abdominal aortic aneurysm screenings to identify vascular abnormalities. There is typically no charge to you for these services if your health care provider accepts assignment.
- Skilled nursing facility care
- Medicare Part A hospital insurance covers all of the approved costs of skilled nursing facility care for the first 20 days if you meet certain criteria. You are responsible for your Part A deductible and a daily coinsurance payment for each day beyond 20 days. After 100 days, you are responsible for all costs.
A Medigap (Medicare Supplement insurance) plan can help you cover out-of-pocket costs for deductibles, coinsurance and copayments.
Does Medicare Pay for Stroke Medication?
Medicare Part A hospital insurance covers medications you receive if you are admitted to a hospital for a stroke. You are responsible for your deductible and coinsurance if you remain hospitalized beyond 60 days.
Original Medicare does not cover the cost of prescription medications your doctor prescribes to prevent a stroke or drugs you have to take after you leave the hospital. But a Medicare Part D prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage may help with out-of-pocket costs.
- Antiplatelet drugs — a type of blood thinner that prevents platelets from sticking together and forming clots. The most common type of antiplatelet drug is aspirin.
- Anticoagulants — a type of blood thinner that prevents new blood clots from forming and keeps existing clots from getting bigger. Examples are Xarelto, Heparin and Warfarin.
- Blood pressure medications — a wide variety of drugs that can be used to lower your blood pressure to prevent strokes. Examples include ACE inhibitors, beta-blockers and diuretics.
- Cholesterol medications — drugs that lower cholesterol. These include statins (Crestor, Lipitor), bile acid resins, niacin, fibric acid derivatives and cholesterol absorption inhibitors.
Medicare Part D prescription drug plans and Medicare Advantage plans, both sold by private insurers, can help cover your prescription medication costs.
Each plan has its own formulary, or list of the prescription drugs it covers. Be sure to check with your plan to see that the drugs you are prescribed are covered. If your prescriptions are not covered, the list should include an alternate medication in the same class that may be substituted.
Medicare Coverage for Stroke Prevention
Original Medicare covers several preventive services that can determine your risk for a stroke and reduce the likelihood that you will experience one.
- Alcohol misuse screening and counseling
- Behavioral therapy for cardiovascular disease
- Cardiovascular disease screening — including a cholesterol blood test
- Counseling to stop smoking or other tobacco use
- Diabetes screenings
- Diabetes self-management training
- Nutrition therapy services
- Obesity screening and counseling
According to the U.S. Centers for Medicare & Medicaid Services, you can prevent 80 percent of recurring strokes through lifestyle changes such as diet and exercise along with medical interventions such as cholesterol-lowering or high blood pressure-lowering medications.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2019, July). Medicare Coverage of Skilled Nursing Facility Care. Retrieved from https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf
- U.S. Centers for Medicare & Medicaid Services. (2019, May 13). Medicare and Stroke Prevention. Retrieved from https://www.medicare.gov/blog/medicare-stroke-prevention
- U.S. Centers for Medicare & Medicaid Services. (2018, May 6). Stroke Recovery — Medicare Can Help. Retrieved from https://www.medicare.gov/blog/stroke-recovery-medicare-can-help
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Inpatient Rehabilitation Care. Retrieved from https://www.medicare.gov/coverage/inpatient-rehabilitation-care
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Occupational Therapy. Retrieved from https://www.medicare.gov/coverage/occupational-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Physical Therapy. Retrieved from https://www.medicare.gov/coverage/physical-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Skilled Nursing Facility (SNF) Care. Retrieved from https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care