If you have a loved one who has suffered a brain injury, you may be feeling overwhelmed. As a caregiver, you might appreciate this useful information, including some words about Medicare coverage of brain injury.

People over 60, and men of all ages, are most at risk of traumatic brain injury, according to the Mayo Clinic.

Brain injury: how does it happen?

A brain injury can be the result of many things, but often results from a fall. In fact, the Family Caregiver Alliance (FCA) reports that 40% of all brain injuries are the result of falls.

Among the milder forms of brain injury is concussion, the FCA reports. Many people aren’t diagnosed with concussion even though they’ve had one, so they don’t have the benefits of medical care or rehabilitation. More severe brain injuries may result in impaired movement, speech, memory, and cognitive abilities.

Brain injury: what you can do as a caregiver?

If you’re a caregiver, you may be involved in helping your loved one with a brain injury regain his or her basic functions. According to the Mayo Clinic, most people who have had a significant brain injury require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities. Therapy may begin in the hospital, continue at an inpatient rehabilitation facility, or through outpatient rehabilitation services. The type and duration of rehabilitation depend on the severity of the brain injury and what part of the brain was injured.

In your caregiver role for a person with brain injury, the FCA suggests you that you help and encourage your loved one to take positive steps to recovery, such as:

  • Join a brain injury support group. Talk to your doctor or rehabilitation therapist about a support group that can help you talk about issues related to your brain injury, learn new coping strategies, and get emotional support.
  • Keep a journal. Write down important events, people’s names, tasks or other things that are difficult to remember since your brain injury.

The Mayo Clinic also has some useful suggestions for helping someone with brain injury. For example:

  • Follow a routine. Keep a consistent schedule, place things in designated places, and take the same route to frequent destinations, like the grocery store or work, to avoid confusion—a frequent result of brain injury.
  • Alter expectations or tasks. Appropriate changes at work or home may include having instructions read to you, allowing more time to complete tasks or breaking down tasks into smaller steps.
  • Stay focused on one task at a time and minimize distractions such as loud background noise from a television or radio that can interfere with concentration.

Brain injury: coping tips for caregivers

The Family Caregiver Alliance (FCA) website says that family caregivers hold an important role in helping a person with a brain injury recover. It’s important to communicate with your loved one’s doctor and healthcare team. This will help you to set realistic expectations, prepare you for behaviors that are uncharacteristic to your loved one, but rather common among people who have suffered brain injury, and allow you to consult with brain injury specialists regarding your loved one’s medication, activities, and challenges.

The road to maximum functionality after a brain injury may be long and involve hard work, the FCA notes. Along the way, you may need to seek the support of community organizations, other family members, home aides, or counselors to help you stay healthy and happy.

Brain injury: does Medicare cover it?

As the caregiver of a loved one with a brain injury, you may be concerned about the cost of treatment. Medicare may cover some costs related to brain injury treatment.

Medicare Part A (hospital insurance) usually covers inpatient care in an acute-care hospital, long-term care hospital, rehabilitation facility, or skilled nursing facility. Part A may also cover temporary home health services. Typically inpatient brain injury care in a hospital or rehab facility requires a deductible per benefit period. You generally pay a daily coinsurance amount for inpatient days 61 – 90, plus lifetime reserve days. Medicare Part A may also cover skilled nursing facility care for brain injury in full for the first 20 days of each benefit period. Generally, Medicare Part A will pay a portion of covered inpatient skilled nursing facility care for days 21 – 100.

Medicare Part A and Medicare Part B may provide coverage for limited home health care as part of the treatment plan for brain injury. You have to meet certain Medicare criteria – for example, that the patient is homebound. Covered home health services might include services and items like:

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech-language therapy
  • Medical equipment needed for brain injury care

This may not be a complete list. Medicare generally pays 100% of the Medicare-approved amount for covered home health services and 80% of the Medicare-approved amount for durable medical equipment.

Medicare Part B typically covers 80% of the Medicare-approved amount for doctor services, outpatient physical and speech therapies, mental health counseling, and outpatient diagnostic tests after you pay the annual Part B deductible.

Medicare Part D may cover medications prescribed to treat brain injury. Contact your Medicare prescription drug plan to verify coverage since plans can have different deductibles, copayment, and coinsurance amounts.

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