Physical therapy can be necessary for many reasons. You might need physical therapy after surgery or need some physical therapy sessions after suffering a fall or injury. These treatments are essential to regain your strength and mobility. However, physical therapy can be expensive, so many people wonder whether Medicare will cover it. If you have Medicare coverage and wonder whether your therapy services will be covered, keep reading. We will give you all the details about Medicare and physical therapy, including which parts of Medicare might cover those health care expenses.
Does Medicare Cover Physical Therapy?
Generally, yes, Medicare covers physical therapy. The details can get a little confusing, though. Whether the therapy sessions are covered by Medicare Part A or Medicare Part B depends on a few factors. The location where you receive your therapy can also play a role in how Medicare pays for it. So, what does Medicare cover when it comes to physical therapy? Here are the details you need to know about physical therapy, Original Medicare, Medicare Advantage plans, and Medicare supplement insurance.
— Medicare Part A
You likely already know that Medicare Part A is hospital insurance that covers hospital stays and inpatient services. Medicare Part A will also pay for physical therapy in some situations. If you receive physical therapy during your hospital stay, then your Part A benefits will likely cover it. Part A coverage will also pay for physical therapy in an inpatient setting, like a skilled nursing facility or rehab center. Finally, Medicare Part A will pay for costs associated with a physical therapist visit at your home if the visit is the result of a hospital stay of three or more days.
— Medicare Part B
Your Medicare Part B benefits will also pay for physical therapy, and Part B generally covers different types of sessions than those covered by Part A. Remember that Medicare Part B is medical insurance that pays for doctor visits, outpatient care, preventive care, and other items. When it comes to physical therapy, Part B will pay for outpatient physical therapy sessions. Part B pays for sessions you receive at a number of different locations. It pays for therapy at a doctor’s office or physical therapist’s office, outpatient nursing facilities, hospital outpatient departments, and even at your home when the services are not covered by Part A.
When Part B covers your therapy services, you will be responsible for paying 20% of the Medicare-approved amount. You must also meet your Part B deductible before this coverage kicks in. While there is no copay associated with physical therapy sessions, your coinsurance amount will be equal to 20% of the Medicare-approved amount.
— Medicare Advantage Plans
Medicare Advantage plans are managed by private insurance companies, and the coverage details of these plans vary greatly. However, each of these plans must provide at least the same minimum level of benefits as Original Medicare. This means that a Medicare Advantage plan will provide at least the same basic coverage as mentioned above for Medicare Part A and Part B. Some Medicare Part C plans provide additional benefits beyond the benefits provided by Original Medicare. These additional benefits often include dental and vision coverage, gym memberships, and other useful items. They might even include additional coverage for physical therapy, speech-language pathology, or occupational therapy. If you have questions about the specifics of your coverage, you should refer to your plan details or contact your insurance carrier.
— Medigap Plans
Many people choose to purchase Medicare supplement insurance to help cover out-of-pocket costs not covered by Original Medicare. These Medigap plans can help cover some of the expenses associated with physical therapy services. Even though Medicare Part B pays for 80% of your physical therapy costs for outpatient therapy, you still have a coinsurance amount of 20% of the cost that you must pay. Your Medigap plan will kick in and pay for those costs. If you have an older Medicare supplement plan, you might even get your Part B deductible paid for. These Medigap insurance plans can be a great way to lower the cost that you will owe your health care provider out of your own pocket.
When Medicare Pays For Home Physical Therapy
Does Medicare pay for home health care physical therapy? Yes, there are several scenarios when Medicare will pay for physical therapy sessions in your own home. While Medicare Part A covers physical therapy that occurs in the hospital during an inpatient stay or therapy services at an inpatient rehabilitation facility, it will also pay for certain home health services related to physical therapy after your release from the hospital. To receive these home health benefits from Medicare Part A, your hospital stay must have lasted at least three days. If the physical therapy treatments are considered medically necessary after the hospital stay, then Medicare Part A will cover the cost of physical therapy in your home.
Medicare Part B covers physical therapy in your home as well. You already know that Part B covers necessary outpatient therapy services at outpatient rehabilitation facilities, but it will also pay for home health care physical therapy sessions. However, a Medicare-certified home health care agency must be your therapy provider in this case. Again, this physical therapy coverage is only in place when your doctor certifies that the physical therapy is medically necessary. So, necessary physical therapy will be covered at 80% of the Medicare-approved amount. Part B will also cover most of the durable medical equipment that is required for your therapy sessions.
Although Medicare Part D does not pay for your physical therapy, it can help pay for prescription drugs that might be necessary for your therapy sessions. If you have a Medicare Advantage health insurance plan, it likely includes prescription drug coverage that could be used in conjunction with your physical therapy coverage.
Medicare Limits On Physical Therapy Sessions
So, are there any limits to the number of physical therapy sessions that Medicare will pay for? For example, some individuals with disabilities, like Parkinson’s disease, may need many more sessions than others who are treating an injury. Thankfully, there is no therapy cap with Medicare. In the past, there was a limit to the number of sessions that would be covered each year, but this cap was eliminated in 2018. This means that Medicare will continue to pay for physical therapy sessions as long as your doctor deems the sessions medically necessary.
Your doctor can authorize up to 30 days of physical therapy sessions at one time. You cannot get blanket approval for therapy sessions that last indefinitely. After 30 days of physical therapy, your doctor must re-certify that the physical therapy is still medically necessary for treatment. The sessions must be re-authorized by your physician every 30 days for Medicare to continue paying for them. Failure to have your doctor re-authorize your physical therapy sessions will likely mean that Medicare will not pay for the sessions that were not authorized.
Cost Of Physical Therapy With Medicare
Medicare used to pay physical therapists based solely on the number of sessions and time spent with the patient at each session. If you are familiar with Medicare’s 8-minute rule, this would often apply to physical therapy sessions as well. However, recently, Medicare has changed its payment method to a value-based approach. The therapists are now paid more on the value they provide to the patient rather than purely the amount of time spent with them. Medicare uses a complex formula to calculate these amounts.
When it comes to how much you will owe out of your pocket for these sessions, the formula is simple. You are generally responsible for paying 20% of the Medicare-approved amount for each physical therapy session. So, if the session costs $100, you will need to pay $20 of the bill. Remember that if Medicare Part B is providing the benefit, you will need to meet your annual Part B deductible before Medicare begins picking up the charges.
You should know that physical therapy sessions are not cheap. Even with Medicare coverage, a physical therapy session might cost you anywhere from $40 to $200 out-of-pocket. A Medigap plan can help cover these costs for individuals who need many sessions. Otherwise, these expenses can really start to add up and can become a financial burden to those people who truly need those services. You can learn more about Medicare billing for physical therapy at CMS.gov.
The Bottom Line
Many people wonder, “Is physical therapy covered by insurance?” The answer is usually yes, especially when talking about Medicare. Both Medicare Part A and Medicare Part B will cover physical therapy, depending on the nature of the therapy and where it is performed. Part A generally covers inpatient physical therapy, while Part B covers outpatient therapy. Both parts of Medicare will pay for physical therapy in your home as long as certain requirements are met. If you have a Medicare Advantage plan, you should check your plan details for coverage specifics. Similarly, most Medigap plans should also help with your out-of-pocket expenses associated with your therapy sessions that are covered by Original Medicare.
Frequently Asked Questions
What percentage does Medicare pay for physical therapy?
The Medicare payment depends on whether your physical therapy is covered by Part A or Part B. Generally, Part A will pay for 100% of the Medicare-allowable charges. This means that your inpatient physical therapy or physical therapy during your hospital stay should be covered at 100%. You will not owe any money out of your pocket for those services. Part B services are covered at 80%. This means that you will owe 20% of the Medicare-approved amount when you receive physical therapy covered under Medicare Part B.
Is there a Medicare deductible for physical therapy?
Yes, there is a deductible for physical therapy. However, the deductible is not specific to physical therapy. You can meet your deductible by paying for any Medicare-covered services. Medicare Part A has an annual deductible of $1,556, while Part B has a deductible of $233. The deductible that you need to meet depends on whether your physical therapy sessions will be covered by Medicare Part A or Part B.
How often can a Medicare beneficiary get physical therapy?
There is no limit to how often a Medicare beneficiary can receive physical therapy. There is also no limit to the number of sessions they may receive. However, the sessions must be deemed medically necessary by your doctor. Your doctor may authorize up to 30 days of physical therapy at a time. After those 30 days, your doctor must re-authorize additional sessions. Failure to receive authorization for physical therapy might mean that your sessions are not covered.
What is the difference between physical therapy and chiropractic care?
Physical therapists generally help you perform stretches and certain exercises aimed at strengthening specific muscles or parts of your body. Chiropractic care, on the other hand, is more focused on the manual manipulation of the spine for the treatment of back pain or neck pain. While chiropractic care is covered by Medicare in some cases, there are very specific rules that must be met to have chiropractic services covered.
