A stroke is a concern for many Medicare beneficiaries. A question our clients keep asking us is how is treatment for stroke different in Inpatient Rehabilitation Facilities and Skilled Nursing Facilities. We’ll explain the first line of care after a stroke.
Hospitalization for Stroke
If you have a stroke you will/should be taken to a hospital immediately. You will be given tests, observed, and it will be determined whether you stay longer in the hospital or moved to an Inpatient Rehabilitation Facility, Skilled Nursing Facility, Out-patient care, or Home Health care.
Your Medicare costs will vary for your hospital stay, but if you are in the hospital for less than 60 days you are responsible for the $1,676 Part A deductible.
Inpatient Rehabilitation Facility and Stroke
Inpatient Rehabilitation Facility (IRF) care, also called acute hospital care, is meant for stroke patients that shows signs of quick improvement. These patients will have 3 hours a day of therapy per minimum of 5 days per week.
IRF Costs
Inpatient Rehabilitation Facility costs fall under Medicare’s Part A hospitalization coverage. The deductible paid at the hospital will roll over to the IRF. Usually patients are only in an Inpatient Rehab Facility for a limited time, but if for some reason your hospital and Inpatient Rehabilitation Facility stay lasts longer than 60 days, your cost will be $419 per day for days 61-90. After that, you have 60 lifetime reserve days at $838 per day.
If you have Medicare Supplement Insurance, aka Medigap, which is meant to fill in Medicare gaps, all plans cover your Part A coinsurance and extend hospitalization days up to 365 extra over a lifetime, and the majority of plans cover part or all of your Part A deductible.
Skilled Nursing Facility for Strokes
If you are moved directly into a Skilled Nursing Facility from the hospital or from an Inpatient Rehabilitation Facility, you must have a 3-day qualifying stay for Medicare, and therefore a Medigap plan, to cover your SNF stay. At a Skilled Nursing Facility you will receive 1 hour per day (5-7 per week) of therapy.
SNF Costs
Your SNF cost with Medicare is $0 for the first 20 days, and $209.50 per day for the next 80. 8 out of 10 Medigap plans cover all or part of your Skilled Nursing Facility coinsurance.
Skilled Nursing vs. Inpatient Rehab
The following compares Inpatient Rehabilitation Facilities to Skilled Nursing Facilities. Remember these are just averages and you should check out the specifics of a facility before you would even need care. It is important to not wait until you need care to decide which facility/facilities are right for you and your family.
Inpatient Rehabilitation Facility
- 24 hour physicians available
- 1 nurse for every 5-7 patients
- In-house emergency care
- Average stay 12-14 days
- 9.4% readmission rate after post-care*
- Do not need 3-day qualifying stay
Skilled Nursing Facility
- Physician visits 1-2 days per week
- 1 nurse per 15-20 patients
- Must be moved for emergency care
- Average stay 21-30 days
- 22% readmission rate after post-care*
- Need 3-day qualifying hospital stay
Final Steps: Planning for a Stroke
No one wants to plan for a stroke or even think about a stroke. But here’s the statistics: nearly 600,000 people over 65 have a stroke each year, according to the National Institute of Neurological Disorders and Stroke. Here’s the list of what our clients have told us helped them before a stroke occured:
- Look into Skilled Nursing Facilities and Inpatient Rehab in your area
- Visit local hospitals
- Speak to your doctor about preventive care for a stroke
- Look into Speech, Physical and Occupational Therapy services
- Learn about Home Health Care services available
- Look into a Medigap benefits that limit your out of pocket costs