Need physical therapy but aren't sure whether or not Medicare will cover it? Here's the answer to the question does medicare cover physical therapy?
If covered by Medicare and have an illness or injury that requires physical therapy, you may wonder, “what does Medicare cover?” More specifically, you'll likely want to know does Medicare covers physical therapy.
In this article, we will look at Medicare coverage for physical therapy and guide you through verifying your benefits if you visit a doctor of physical therapy.
Check Your Coverage
If Original Medicare covers you, your benefits will differ from coverage under a Medicare Advantage Plan. Medicare Part B does have benefits for outpatient medical services and therapies. With a Medicare Advantage Plan, you have all the coverage of Parts A and B, plus additional services and benefits.
Does Medicare Cover Physical Therapy?
Yes! Under Original Medicare Part B, if medically necessary physical therapy is covered. The laws governing Medicare no longer limit how much Medicare pays for physical therapy in a calendar year.
If you have a Medicare Advantage plan, you may be required to use an approved physical therapist in your plan's network.
How Much Will I Have To Pay?
Medicare is a co-insurance program. That means you pay 20 percent of the cost after you meet your deductible. Medicare pays for up to 80 percent of the approved amount.
Medicare covers up to $$2,110 for physical therapy before your doctor must specify your care is medically necessary. And since Medicare pays 80 percent of this cost, your portion is $416.
If you have a Medicare Advantage plan, you will likely pay a co-pay instead of the 20 percent co-insurance. Co-pays vary by plan.
The specific amount you will pay for physical therapy services will depend on the type of Medicare plan you have, your doctor's charges for their services, and the type of facility where the service you visit. Always discuss costs with your healthcare provider, so you have a clear understanding of your financial responsibility.
Where Can I Receive Physical Therapy?
Medicare benefits are available for therapy provided at your doctor's office or physical therapist. Medicare covers comprehensive Outpatient Rehabilitation Facilities, Skilled Nursing Facilities, and some home health agencies.
How Do I Know If My Therapy Is Medically Necessary?
Medicare defines medically necessary as “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” If your provider is a professional physical therapy practitioner, they can help you determine if Medicare covers your therapy services.
Suppose Medicare determines your therapy not to be medically necessary. In that case, you or your doctor will receive an Advanced Beneficiary Notice of Non-Coverage (ABN). You do have the option of appealing this decision.
Find the Right Option For You
Does Medicare cover physical therapy? Yes, it does. It will be covered by Original Medicare or a Medicare Advantage plan as long as the physical therapy is medically necessary.
If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.