Medicare Stroke Costs: Out-Patient Therapy vs. Home HealthCare

Learn the difference between out-patient care and Home Health Care

by Amy De Vore+ on May 11, 2015 | 6 Comments

After a stroke, Medicare may offer out-patient care or Home Health Care services to help with your stroke rehabilitation. Here are the differences between the two types of care.


Out-Patient Physical, Speech, and Occupational Therapy

Out-patient physical, speech-language pathology, or occupational therapy helps with your motor, speech, and daily activities. This is especially important if there is paralysis after a stroke. This is when you go to a medical facility that provides this type of care.

Therapy Costs
Medicare Part B puts therapy limit caps. Physical and speech-language pathology are combined for a therapy limit cap of $2,010. Occupational therapy has a separate therapy limit cap of $2,010. Medicare will expand its coverage if your therapist deems your therapy medically necessary and Medicare approves it. It is unclear if this is the limit that Medicare pays or the limit you pay.

All Medicare Supplement (Medigap) plans cover all or part of your Part B coinsurance, but only two plans, Medigap Plan C and Medigap Plan F, cover your Medicare Part B deductible ($185).

Home Health Care for Strokes

Home Health Care is varied coverage dependent upon the individuals needs. A physical, speech, and/or occupational therapist may come to your home, as well as the home health care specialist will check on your eating habits, if you’re taking your medication, home safety, and other care. Home Health Care is not custodial care (only feeding, dressing, and bathing). Medicare does not cover custodial care.

Home Health Care Costs
With Original Medicare there is no cost to the patient for Home Health Care visits, because it is so much less expensive than having a patient in an Inpatient Rehabilitation Facility or Skilled Nursing Facility. However, if you need durable medical equipment, you will pay 20% of the cost with Part B. If you have Medigap, depending on the plan, it will cover all or part of your Part B coinsurance.

Planning for a Stroke

No one wants to plan for a serious illness, but if you plan ahead it’s helps for you or your loved one to receive the best care. Our clients have told us by doing the following their care after stroke went smoothly:

  • Look into therapists in your area
  • Visit Skilled Nursing Facilities
  • Visit Inpatient Rehabilitation Facilities
  • Take a tour of local hospitals
  • Look into Long Term Care
  • Check out Medigap plans to reduce out of pocket costs

For more questions about Home Health Care or Therapy services for stroke patients call the number above or if you’re ready click here to get a Medicare Supplement quote.


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Reader Comments and Questions

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By Mary Janek on February 28, 2017

My mother suffered a stroke Dec 7 and was admitted into a nursing home. Jan 16 I tried to place her in an assisted living facility but it didn't work out. I brought her home with me. She has become increasingly difficult for me to care for. Since she still had time left for the stroke event is she able to go back to the nursing home to complete the remaining approximately 90 days left for that event or would it have to be a completely event?

Thank you for your question. However, without more details we wouldn't be able to give a specific answer. You'll want to contact Medicare directly to find out if she would be covered.
-Michelle from

By Robert Ganung on April 26, 2016

My 88 year old father had a stroke a few days ago. He needs some one to look after him 8 hours a day during my work day while he receives treatment. he cannot be left alone. Does medicare cover a home, health care person? He may have supplemental thru his Electrical union but not sure. Can you help here?

Medicare covers Home Health Care, but only if it isn't only for custodial care (bathing, eating, cleaning). He is also covered for Skilled Nursing Facility care if he had a three day qualifying hospital stay, and he qualifies for round the clock nursing care. You will want to contact Medicare, his doctor for recommendations, and his Supplement plan to see how he will be covered. Best of luck!
-Eric from

By gail on April 04, 2016

can a person get medicap after they have had a stroke and price?

If you are in your Medicare Supplement (Medigap) initial enrollment period or have a guaranteed issuance period, you can enroll in a Medigap plan even right after a stroke and not have to answer medical questions. If you do not qualify for one of these enrollment times, you can apply for a plan, but you will have to answer medical questions. First, you'll want to , and then call one of our licensed independent insurance agents at 800-930-7956 to help you find the right Medigap plan for you.
-Chris from

By Jim Waite on July 16, 2015

My mother after her stroke needed a lot of DMEs from a walker to a new shower head to a seat for the shower, as well as physical and speech therapy. She didn't have any type of supplemental insurance, and I had to pay it out of pocket. I cannot stress enough how the little things nickel and dime you death. Not to mention the hospital deductible. Get Medigap. It will save you lots of money when you need it.

By Rick S. on June 10, 2015

I've heard acupuncture treatment for stroke patients can be very helpful. Does Medicare cover that?

Unfortunately, Medicare does not cover acupuncture. It does however cover physical therapy.
-Jacima from

By Edward King on May 12, 2015

My wife had a stroke and needs both physical and speech therapy. That cap seems really low for both. Is there anything we can do?

Thank you for your question. As far as we know, if a doctor states that it's medically necessary to continue therapy Medicare may increase the cap. So, we suggest speaking with your wife's doctor.
-Amy from

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