What's Your Stroke Risk + Will Your Health Insurance Cover the Costs?

Cathy Jakicic
August 18th, 2020 May 5th, 2020 |
Read time: 9 minutes
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About every 40 seconds. That’s how often someone in the U.S. has a stroke, according to estimates from the Centers for Disease Control and Prevention (CDC).[1]

In fact, stroke is the fifth leading cause of death and the leading cause of serious, long-term disability in the United States.[2]

What causes a stroke? A stroke occurs when a blood vessel to the brain is either blocked by a clot or bursts. When brain cells in the affected area cannot get the blood (and oxygen) they need, they can die.[3]

A stroke caused by a clot is called an ischemic stroke. One caused by a ruptured blood vessel is called a hemorrhagic stroke. A TIA (transient ischemic attack or transient cerebral ischemia), or “mini-stroke,” is caused by a temporary clot.[4]

While a stroke may be considered a risk that comes solely with age, strokes can occur at any stage of life. Nearly one-fourth of strokes occur in people under the age of 65.[5]

There are a number of factors that could put you at a higher risk for a stroke, in the remainder of this article we’ll talk about:

  • Risk factors for a stroke
  • Reducing stroke risk factors
  • The potential costs of treating a stroke
  • Health insurance options that can help with costs

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What Are Risk Factors for a Stroke?

When we talk about risk factors, it’s important to remember that these are factors that correlate to an increased risk of stroke, which is not the same as saying these factors cause stroke.

Risk factors for stroke include:

Age – Stroke is most common among the elderly.[6]

Family history + chronic disease – If your family has a history of any health conditions or diseases that cause stroke, like high blood pressure, diabetes,[7] or sickle cell disease, you may have a higher likelihood of developing that condition and the associated stroke risk.[8]

Race plays a significant role in healthcare and health outcomes in the U.S.[9] As a result, Black, Hispanic and Native Americans are consistently rated at a “higher risk” for developing and dying from a number of diseases, including stroke.[10] This is at least in part because they are less likely to receive preventive care and often receive lower-quality healthcare to help treat these diseases.[11]

Sex can also be a factor with women having a higher risk. Women generally live longer than men, which can mean more women have strokes later in life, as well as after menopause when hormone changes or hormone therapy may increase risk.[12]

Additionally, some factors specific to women’s reproductive health may increase stroke, such as pregnancy, preeclampsia/eclampsia, gestational diabetes, and oral contraceptives use.[13]

Experiencing a prior stroke, transient ischemic attack (TIA), or heart attack increases your risk.[14]

Experiencing chronic poverty, unemployment, and lack of access to primary stroke centers (PSCs) can increase your risk for dying of stroke. These conditions are most prevalent in the southeastern U.S., including Arkansas, Tennessee, North Carolina, Mississippi, Louisiana, Alabama, Georgia, and South Carolina.[15]

Income could be a factor as stroke is more common among low-income Americans[16] who are also more susceptible to higher rates of alcohol and tobacco use, and an increased risk of health problems developing or worsening over time.[17]

You can also take the Stroke Risk Quiz (PDF) provided by the American Heart Association and the American Stroke Association.

Can You Reduce Your Risk of Having a Stroke?

Since stroke is often a symptom of an underlying health condition, one way to reduce your risk of stroke is to adopt a health-promoting lifestyle that reduces your chance of experiencing a chronic health condition like heart disease, diabetes, or kidney disease.

Let’s look at some health-promoting behaviors and habits that you may be able to control, to help reduce risks associated with stroke:[18]

Quit smoking.

Diet – Eat a variety of nutrient-rich, health-promoting foods, like fruits, vegetables, and whole grains, and make sure your diet supports your health goals, such as reducing sodium intake if you have high blood pressure.

Healthcare – Get regular care for and effectively manage underlying heart, artery and blood conditions that could increase stroke risk — for example, high cholesterol, high blood pressure, carotid artery disease, peripheral artery disease, atrial fibrillation, sickle cell disease, and congenital heart conditions.

Increase your physical activity — aerobic exercise and resistance training are the most effective for maintaining heart health.[19] But even just moving more and sitting less can help.[20]

Get enough sleep. Not getting enough sleep, or having a sleep disorder, can negatively impact cardiovascular health and increase the risk for disease.[21]

Consume alcohol in moderation; do not use drugs. Some drugs that have been found to increase stroke risk include cocaine, amphetamines, and heroin.[22]

The Potential Costs of Treating a Stroke

Treatment for a stroke can come at a considerable cost. Along with heart disease, stroke is a leading cause of medical bankruptcy.[23] How much treatment, hospitalization and potential rehab, can vary, but here are some examples.

  • Hospitalization for a stroke can cost from $5,272 to $16,475+[24]
  • Hospitalization for transient cerebral ischemia can cost from $5,738 to $17,930+[25]

Overall, including the cost of healthcare services, medication, and missed days of work, strokes cost the United States an estimated $34 billion each year.[26]

Health Insurance to Help With Costs From a Stroke

With the high costs related to treating stroke, what health insurance options should you consider? We’ll cover a couple of different insurance products below, including comprehensive ACA-qualifying medical insurance, and supplemental medical insurance plans like hospital indemnity insurance, gap medical insurance and critical illness insurance that could be good options depending on your situation.

ACA-Qualifying Major Medical Insurance

Preventive and wellness services and chronic disease management are essential health benefits required by the Affordable Care Act (ACA), for ACA-qualifying health plans. Treatment for diabetes and high blood pressure, two common causes of a stroke, would most likely be covered with the exception of deductible, copays, and coinsurance.[27]

The ACA also mandates that there be no annual or lifetime benefits limits to your major medical insurance coverage for essential health benefits,[28] which can be vital protection if you’re dealing with a chronic health condition.

Because of the protections afforded by the ACA, including that policies are guaranteed-issue, meaning that applicants are not denied coverage or charged more for a pre existing condition,[29] major medical, or another form of qualifying coverage is probably your best option for comprehensive benefits.

Supplemental Critical Illness Insurance

Even with a major medical policy, medical treatment, and recovery from a stroke may come with considerable out-of-pocket costs. In addition to the deductible, copays, and co-insurance, there are your major medical premiums and possible out-of-network costs.

These costs can add up, particularly if you have a high deductible or narrow network health plan.

One option that may be able to help is adding supplemental critical illness insurance alongside your major medical policy. These policies generally come at a relatively low premium, but only cover a limited number of illnesses, such as a heart attack, stroke, or cancer.[30]

Critical illness insurance usually pays a lump sum. This can typically range from a few thousand dollars to $100,000 in benefits, sometimes more. Benefits help with costs that may not be fully covered by major medical insurance. These costs can include medical expenses, such as ongoing therapy, nursing facilities, and medication[31] or for non-medical costs related to the illness, like transportation or childcare.

These policies pay out once and then are done.[32] In addition, critical illness insurance may not be guaranteed-issue, so you have to be approved by the carrier in order to enroll in a policy.

Premiums for these plans depend on a number of factors, including the amount of the benefit you choose, your gender, age, and health and family history.[33]

While it’s difficult to predict what level of benefits you may need in the future, according to some financial planners, $50,000 is an amount that would probably make a meaningful difference in dealing with medical expenses.[34]

Whether or not critical illness insurance is a good option for you also depends on a number of factors, including whether or not you have funds to cover your major medical policy’s out of-pocket-costs, other supplemental insurance you may have access to such as through an employer and if you are able to qualify for a critical illness insurance policy.

Learn more about critical illness insurance and whether or not it’s worth it.

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The other supplemental insurance you may want to consider include gap health insurance and hospital indemnity insurance. Both of these types of plans can help cover the high costs of hospitalization. Gap provides supplemental benefits as a lump sum. Hospital plans provide benefits as a fixed amount on a per-event, day, week, month, or visit frequency.

Summary + Next Steps

We’ve covered a lot of information in this article, including stroke risk and ways you may be able to mitigate it.

While some risk factors for stroke are beyond our control, making certain lifestyle choices can help manage or improve health outcomes for a range of diseases that are associated with strokes.

ACA-qualifying health insurance such as major medical insurance is your best option for coverage for chronic or critical illnesses, such as those associated with stroke, but additional supplemental critical illness, medical gap or hospital insurance may be able to help with out-of-pocket costs and other expenses if you are able to qualify.

If you’re considering supplemental coverage, call 888-855-6837 to speak with an agent to review your options, or obtain quotes for the health plans you’re considering to compare costs and coverage.

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Originally Published On May 5th, 2020
Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

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