Medicare coverage for physical therapy is available. In some cases, you’ll need physical therapy to get back on your feet.
Whether you’re in an accident or you have a medical condition, therapy can improve the quality of life.
Let’s take a look at how Medicare covers physical therapy and what costs you could be responsible for paying. Then, we can discuss plan options that can save you money.
Medicare Physical Therapy Coverage
Medicare covers physical therapy that’s medically necessary. Physical therapy during or after hospitalization is Part A.
Part B’s medical coverage pays for outpatient or at-home physical therapy. You may have to pay part of the cost.
You may obtain therapy in a hospital, skilled nursing facility, outpatient physical therapy center, or in your home.
Medicare Coverage for Physical Therapy in Rehab
With inpatient physical therapy, Part A covers. If you’re in the hospital for at least three days, Part A also pays for therapy in a skilled nursing facility after discharge.
Physical Therapy Coverage at Outpatient Facilities
If your doctor prescribes physical therapy and you haven’t been hospitalized, Part B will cover your therapy. Although, deductible and coinsurance will apply.
So, be ready to pay a portion of the bills.
At-Home Physical Therapy and Medicare
If you qualify for home health benefits, Medicare will pay the full cost of physical therapy in your home.
- Be under a doctor’s care
- Improve or to maintain your current physical condition
- Have your doctor must certify that you’re homebound
Also, Medicare pays a portion of the cost for Durable Medical Equipment used in your home therapy.
Medicare Rules for Physical Therapy
In the past, Medicare paid physical therapists based on the number of visits and the amount of time they spent with patients. To keep costs down and improve care, Medicare adopted a value-based approach to physical therapy beginning in 2020.
Therapy doctors are now paid based on a complex formula that considers several factors related to a patient’s needs.
Doctors can authorize up to 30 days of physical therapy at a time. But, if you need physical therapy beyond that 30 days, your doctor will need to re-authorize it.
Medicare Physical Therapy Cap 2020
Medicare used to have a cap on the number of physical therapy sessions you could have in a year. These physical therapy limits were removed in 2018.
You can have as much physical therapy as is medically necessary each year.
Physical therapy is known as “physiotherapy” in many parts of the world, including Canada, Europe, and Australia. Some physical therapy doctors in the U.S. may use the term “physiotherapy” to describe what they do.
Medicare will cover your therapy, regardless of whether it is called physical therapy or physiotherapy.
Medicare Advantage Plans and Physical Therapy
Advantage plans must cover the same as Medicare, or better. So, you can expect physical therapy to be part of the policy.
The only thing, costs can vary from between plans. Further, you’ll need to stay in-network to obtain proper coverage.
If you anticipate needing physical therapy, consider choosing the policy that covers more than just a portion of the bill.
Medigap and Physical Therapy
When you have Medigap, the plan pays your portion of the coinsurance bill. Some plans even cover deductibles.
Those that anticipate needing physical therapy should consider Medigap.
To better explain how Medigap could benefit someone in need of physical therapy I’m going to use Josie as an example.
Josie needs physical therapy for her knees. Well, she chose to go with Plan G because she knows her needs to frequently visit the doctor offices.
Since Josie has Medigap Plan G, she will pay her premium and the Part B deductible. If Josie has inpatient physical therapy, she won’t pay anything other than her monthly premium.
But, with outpatient physical therapy, Josie will pay the Part B deductible. If Josie didn’t have Medigap she could be responsible for deductibles and a portion of the bill.
Medicare and Physical Therapy FAQ’s
Get Help Paying for Physical Therapy
Physical therapy can make a huge difference in your healing process after an injury or illness. And, it can help you manage chronic health issues.
Our agents know the benefits of having quality coverage. To find the most suitable plan option for you, give us a call at the number above today!
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