Scott Kammerer, Medicare Insurance Broker

What does Medicare cover for stroke recovery and rehabilitation?

Answer: Thanks for your question! The answer mainly depends on what services are received and where they take place.

While a patient is hospitalized, they will receive coverage under Medicare Part A for inpatient care, services and supplies. This coverage would include any rehabilitation done as a hospital inpatient. Physician services received during this period would generally fall under Medicare Part B.

After discharge from the hospital, patients who need additional rehabilitation in a Skilled Nursing Facility (SNF) continue to be covered under Part A, with a $0 copay for days 1-20 and a $217 copay for days 21-100 in the facility. Medicare coverage for the SNF ends after 100 days.

Once returning home, Medicare Part B will cover necessary outpatient therapy such as physical therapy and/or occupational therapy. These generally require a 20% copay for services, after the patient has met the Part B deductible of $283. Note that if the patient is medically certified as homebound and meets the other requirements of Medicare, they may be eligible for covered home health services with $0 cost sharing.

Finally, cost sharing may be very different for a Medicare beneficiary enrolled in a Medicare Advantage plan. Consult your plan's Summary of Benefits or Evidence of Coverage for specifics.