Does Medicare Cover Physical Therapy
For retirees, staying healthy is essential to enjoying vacations and time with their loved ones. But what happens if you start experiencing pain or discomfort?
Depending on your situation, Medicare may cover physical therapy.
Keep reading to learn more about how Medicare works and whether or not it can help you get the treatment you need.
Table of Contents
Does Medicare Pay for Physical Therapy: Inpatient and Outpatient Physical Therapy?
Inpatient Physical Therapy: Inpatient Rehabilitation Facility
Medicare Part A covers inpatient physical therapy for people who are hospitalized for at least one night as a result of their injury/health condition. This coverage can be used to help treat any injuries that were sustained and requires hospitalization due to an accident, including fractures, sprains, contusions, and strains.
Once a Medicare Beneficiary is released from the hospital, Medicare will continue to pay for medically necessary outpatient physical therapy covered by Part B of Medicare.
Outpatient Physical Therapy?
Many people turn to outpatient physical therapy when they need treatment but no longer require hospitalization. Outpatient physical therapy can help patients recover from injury more quickly and avoid long-term pain and disability.
Depending on the injury or condition, outpatient physical therapy may also include exercises, treatments, or both. In addition to treating injuries and conditions, outpatient physical Therapy can also improve overall fitness levels and provide relief from stress.
Outpatient therapy covers medically necessary physical therapy under Medicare Parts A and B as long as the physical therapist or doctor is contracted with Medicare.
If you’re experiencing pain or suffering from an illness that’s affecting your mobility, outpatient physical therapy could be the solution for you. Contact a specialist to see if it’s right for you!
Does Medicare Cover Physical Therapy: Covered by Medicare Part A or Medicare Part B
Medicare Part A covers inpatient rehabilitation services while Medicare Part B covers medically necessary outpatient rehabilitation services.
Medicare covers physical therapy to help people recover from a physical injury or illness. This is important because it can help people regain their mobility and function more fully.
Outpatient rehabilitation services are typically provided at clinics or hospitals, rather than your home, which means that you can receive care and Medicare will pay for your physical therapy.
The coverage for physical therapy under Medicare depends on the type of service that you need and your doctor must show that physical therapy is medically necessary. Medicare benefits can be covered by Original Medicare and Medicare Advantage (Part C Plan).
If you have Original Medicare it is imperative to also buy a Medicare Supplemental plan to cover the costs not covered by Original Medicare.
It’s important to know whether your insurance plan includes coverage for physical therapy so that you can get the treatment that you need without having to worry about costs.
What are Outpatient Rehabilitation Services?
Outpatient rehabilitation services help people who have injured or damaged bones, muscles, ligaments, tendons, and other tissues. They may also help people with conditions like arthritis.
The goal of outpatient rehabilitation is to improve the patient’s ability to function at home and in their community.
Outpatient rehabilitation services are usually provided by physical therapists (PTs). PTs work with patients one-on-one to help them recover from their injuries.
People who need outpatient rehabilitation usually go to specialized centers called rehab hospitals or clinics. Rehab hospitals specialize in treating different types of injuries and offer more extensive treatment than clinics do.
Medicare will cover outpatient rehabilitation services and other types of therapy needed by the Medicare Beneficiary.
What Medicare Plans Cover Physical Therapy: Medicare Coverage (Medicare Part C Plans and Medigap Plans)
Best Medicare Advantage Plan Coverage for Physical Therapy?
The best Medicare Advantage plan coverage for physical therapy depends on your needs and budget. Some plans have more comprehensive coverage than others, but all of them should include at least some type of coverage for physical therapy.
If you’re looking to save money on your medical bills, it’s essential to compare the cost of each Medicare Advantage plan before making a decision.
The Centers for Medicare and Medicaid require all Medicare Advantage plans to provide a minimum standard of health care insurance coverage.
When choosing a Medicare Advantage plan, it’s also important to consider your health status and whether you’ll need any additional benefits (like basic dental, vision care, and Part D prescription drug coverage) in the future.
Medicare Advantage plans are mostly HMO plans which require Medicare Beneficiaries to only use doctors and medical facilities covered by the plan. Your therapy provider must be listed as a covered provider under your plan to be covered under Medicare.
Your Medicare Advantage plan may limit the number of physical therapy visits, so it is vital to understand your plan’s benefits before receiving treatment.
Working with a Medicare insurance agent will help you find a Medicare Advantage plan that is both cost-effective and covers your needed doctors.
Best Medicare Supplement Insurance Plan to Cover the Cost of Physical Therapy Sessions?
People needing physical therapy turn to Original Medicare with a Medigap plan to receive health insurance coverage. Medigap Plan G is the most popular and best Medicare Supplement plan available today, as it covers 100 percent of your medical bills once you meet your Part B deductible.
Physical therapy is covered by Original Medicare with a Medigap Plan as long as the treatment is considered medically necessary by your treating physician.
These plans give you the added flexibility to utilize your Medicare coverage for physical therapy without needing a referral or prior approval from an insurance company. If physical therapy is necessary, make an appointment with the doctor you select. There are no network restrictions with Original Medicare with a Medigap plan.
If you’re interested in physical therapy but don’t want to spend extra money on coverage, consider using a Medicare supplement policy as an additional form of protection. These policies are usually affordable and easy to use and can help cover some of the costs associated with physical therapy treatments.
How do I find a Physical Therapist that Accepts Medicare Physical Therapy Coverage?
There is no one-size-fits-all answer to this question, as the coverage and benefits of physical therapy services will vary depending on the individual Medicare plan.
To find out whether your Medicare plan covers outpatient rehabilitation services, you can contact your insurance company or consult a healthcare provider specializing in Medicare coverage.
If you have a Medicare Advantage Plan, your primary care doctor will help you locate a physical therapist covered by your plan. However, if you are enrolled in Original Medicare with a Medigap plan, you have the freedom to use any physical therapist throughout the country.
Your treating physician can provide you with a recommendation of their top 3 best physical therapists if you need help.
Does Medicare Cover at-home Physical Therapy: Home Health Care Benefits
Yes, Medicare covers physical therapy at home.
Medicare covers physical therapy services performed in a person’s home by a licensed Physical Therapist. This includes outpatient rehabilitation services for people who have been injured and need help recovering at their own pace.
Physical therapy can help people with injuries to improve their quality of life and function more effectively. It can also help them recover from surgery or other medical procedures.
Home health care providers must be licensed and meet Medicare requirements, so you can be sure that your treatment will be safe and effective.
Do you need a Doctor’s Referral or Prescription to Recieve Physical Therapy Benefits: Medicare and Physical Therapy
Original Medicare with a Medigap Plan Cover
For Medicare Beneficiaries enrolled in Original Medicare with a Medicare Supplement plan, you do not need a referral or prescription to receive physical therapy benefits.
The level of coverage of a Medicare supplement plan depends on the type of plan you choose. Many Medicare Beneficiaries buy the Medigap Plan G as it provides the most significant benefits.
However, suppose you are looking to save on your monthly premium while picking up more costs related to using your health benefits. In that case, a Medigap Plan N is an alternative option that may also cover physical therapy.
If you need coverage for outpatient physical therapy but don’t have insurance or aren’t sure whether it’s covered under your current policy, reach out to one of our experienced Medicare representatives licensed in your state.
They will review the different parts of Medicare and discuss how much Medicare includes under each plan option you are considering.
Medicare Advantage Plans
If you’re enrolled in Medicare Part A and B, you might be able to enroll in a Medicare Advantage plan. These plans are often cheaper than traditional Medicare and include health benefits like physical therapy.
Before you can receive treatment from a specialist, you may be required to obtain a referral from your Medicare Advantage plans. Most Advantage plans are HMO programs that require Medicare Beneficiaries to receive approval from the insurance company before receiving health care benefits.
It is also critical to verify your physical therapist is approved by your Medicare Advantage plan before receiving each treatment. While a doctor may accept Medicare, they may not accept your Medicare Advantage plan within their office.
Medicare Beneficiaries receiving treatment from an out-of-network doctor may be responsible for 100 percent of the costs based on the Medicare Advantage plan enrolled.
How many Physical Therapy Treatments will Medicare pay for Annually: Physical Therapy Cap on Coverage
Medicare covers outpatient physical therapy services, but only up to 48 per year. This limit is based on the number of outpatient treatment visits under Medicare guidelines.
Outpatient physical therapy treatments include any treatment provided outside an individual’s hospital or doctor’s office and are not considered a part of their regular medical care. This includes home exercises and activities designed to improve mobility and function.
Suppose you receive more physical therapy treatments than your plan allows. In that case, you will want to ensure Medicare will provide approval for the additional visits before seeking treatment that exceeds your annual allotment.
It is critical to work with your doctor and their billing department to avoid exceeding your available number of treatments.
How much will Physical Therapy Cost?
Medicare Supplement Plan Costs
There are ten different Medicare Supplement plans available to Medicare Beneficiaries.
The 10 Medigap Plans Include:
- Medigap Plan A: This is the most basic of all the plans and covers the core benefits.
- Medigap Plan B: This plan covers all of the benefits of Plan A and some out-of-pocket costs that are not covered by Medicare Part A and Part B.
- Medigap Plan C: This plan covers all of the benefits of Plan B, plus some out-of-pocket costs that are not covered by Medicare Part A and Part B, such as the Part A deductible and the Part B coinsurance.
- Medigap Plan D: This plan covers all of the benefits of Plan C, plus some out-of-pocket costs that are not covered by Medicare Part A and Part B, such as the Part A deductible, the Part B coinsurance, and the Part B deductible.
- Medigap Plan F: This is the most comprehensive of all the plans and covers all of the benefits of Medicare Part A and Part B, plus it covers all of the out-of-pocket costs that Medicare does not cover.
- Medigap Plan G: This plan covers all of the benefits of Medicare Part A and Part B, plus it covers all out-of-pocket costs that are not covered by Medicare, except for the Part B deductible.
- Medigap Plan K: This plan covers 50% of out-of-pocket costs that Medicare Part A and Part B are not covered.
- Medigap Plan L: This plan covers 75% of out-of-pocket costs that Medicare Part A and Part B are not covered.
- Medigap Plan M: This plan covers all of Plan A’s benefits, plus 50% of the out-of-pocket costs that are not covered by Medicare Part A and Part B.
- Medigap Plan N: This plan covers all of the benefits of Plan A, plus some out-of-pocket costs that are not covered by Medicare Part A and Part B, such as the Part B coinsurance.
Each Medicare Supplement plan is offered by a private insurance company and differs in terms of coverage and cost. The most popular choice is Medicare Supplement Plan G, which provides the most comprehensive coverage available today for new Medicare Beneficiaries.
Medicare Advantage Plan Costs
The costs of Medicare Advantage plans can start to add up once you begin to lean on the coverage due to a health condition. While many do not charge an additional monthly premium, they can include significant copays, coinsurance, deductibles, and max out-of-pocket costs.
In 2022 the max out-of-pocket costs allowed is $7,550 for in-network services for HMO plans and $11,300 for in-network and out-of-network services combined for PPO plans.
As each Medicare Advantage plan has different costs, it is essential to call your plan provider and inquire about how much physical therapy will cost you under your specific plan.
Frequently Asked Questions
What are outpatient rehabilitation services?
Outpatient rehabilitation services can help people with physical or mental health issues improve their quality of life by providing treatment and rehabilitation in a setting close to home. This type of care can be helpful for people who need short-term assistance in recovering from an injury, illness, or other condition.
Outpatient rehabilitation services can also be helpful for people who have difficulty accessing traditional medical or psychological treatments due to a lack of time or resources.
What are the benefits of physical therapy?
Physical therapy can provide benefits such as reducing pain, improving range of motion, and increasing strength. In some cases, physical therapy may be a person’s only treatment to recover from an injury or disease.
Physical therapy also has a positive impact on a patient’s mental health. Patients who receive physical therapy often feel more confident and able to resume their normal activities.
Is Occupational Therapy Covered by Medicare?
Yes, occupational therapy is covered by Medicare. Medicare pays for occupational therapy services considered medically necessary for treating an illness or injury. Occupational therapists can help patients regain skills and independence after an illness or injury.
Can I receive Physical Therapy Coverage while in Skilled Nursing facilities?
Yes, you can receive physical therapy coverage while in skilled nursing facilities. Your insurance company may cover some or all of your physical therapy costs, depending on your policy. You can also check with your state’s Medicaid program to see if they cover physical therapy in skilled nursing facilities.
Who is Eligible for Medicare
To be eligible for Medicare, an individual must be 65 years or older or have a qualifying disability. They must also be a citizen or permanent resident of the United States.
What is My Medicare Part B Deductible in 2022
The Medicare Part B deductible in 2022 is $233. You must pay this amount before your Medicare Part B coverage kicks in. After you meet your annual deductible, you will only be responsible for paying 20% of the cost of your Medicare-covered services unless you buy a Medigap plan.
Need Help With Your Medicare Insurance Coverage?
Integrity Now Insurance Brokers has been helping older adults with their Medicare needs for over 20 years. Our team of insurance experts is here to assist you throughout the entire process to help you find the best plan for you.
Did you know that an independent Medicare Broker can save you thousands of medical bills? Yes, this is a fact! Using a Medicare broker gives you free access to help find a Medicare plan from multiple insurance companies and plans.
Independent insurance agencies specializing in Medicare are not tied to a single insurance company and can obtain quotes from all insurance companies they represent in your local area.
Contact us today at 562-735-3553 or complete our online quote request form.