Medicare covers physical therapy in both home and hospital settings for inpatient and outpatient treatment. It’s also available for telehealth meetings. Seniors typically have plenty of questions about Medical coverage because it’s such an expansive topic. Here are essential points to know about Medicare for physical therapy.
Table of Contents:
- Coverage for Inpatient and Outpatient Physical Therapy
- Scenarios When Medicare Won’t Cover Physical Therapy
- Do Different Medicare Advantage Plans Have Different Levels of Coverage for Physical Therapy?
- How Medigap Supplements Coverage for Physical Therapy?
- Telehealth Visits for Physical Therapy
- Coverage for Physical Therapy at Home (Home Health)
- Do You Need a Doctor’s Referral or Prescription to Have Medicare Cover Physical Therapy?
- How Many Physical Therapy Sessions Will Medicare Pay for?
- What Will You Have to Pay for Physical Therapy Out of Pocket?
- Explore Your Coverage Options with Medicare Advisors
Coverage for Inpatient and Outpatient Physical Therapy
Inpatient and outpatient physical therapy are covered by Medicare only if it’s medically necessary. It can be in various settings such as a hospital, care facility, office, or home. Usually, Medicare covers most of these costs. Part A covers all the costs after your deductible if you are enrolled in original Medicare.
Scenarios When Medicare Won’t Cover Physical Therapy
Your Medicare for physical therapy coverage has a limit, which in 2022 was $2,150. But you can still receive additional coverage if your therapist finds it to be medically necessary. Otherwise, medically unnecessary physical therapy will not be covered.
Do Different Medicare Advantage Plans Have Different Levels of Coverage for Physical Therapy?
A popular option to original Medicare is Medicare Advantage, which does offer more benefits by comparison. Yet the U.S. Department of Health and Human Services has found from its 2022 study that traditional Medicare provides better odds for approval of prior authorization requests. Over a tenth of Medicare Advantage enrollees in the study could not access therapy services available in the original plan.
How Medigap Supplements Coverage for Physical Therapy?
A supplemental form of Medicare is called Medigap, as it fills coverage gaps in Parts A and B. Medigap helps reduce your costs for deductibles, copays, and coinsurance. Most of these plans also pay for physical therapy in a skilled nursing facility. You can get a better idea if you need Medigap by talking with a Medicare expert.
Telehealth Visits for Physical Therapy
Yes, your Medicare coverage includes telehealth visits with a physical therapist. During the COVID-19 pandemic, Medicare opened up more comprehensive coverage for telehealth, which helped reduce crowds at hospitals. Some of this coverage may expire soon, but the American Medical Association (AMA) is addressing Congress to extend Medicare coverage for telehealth services.
Coverage for Physical Therapy at Home (Home Health)
The rules for telehealth coverage have changed since 2020, moving in the direction of more flexible coverage for home health. You now can get broader coverage for physical therapy at home, as well as for speech and occupational therapy. Some patients, however, are still denied coverage for home therapy.
Do You Need a Doctor’s Referral or Prescription to Have Medicare Cover Physical Therapy?
In 2005 Medicare began allowing physical therapy coverage without a doctor’s referral or prescription. Patients simply need to be under the care of a physician to be eligible for this coverage.
How Many Physical Therapy Sessions Will Medicare Pay for?
Medicare will actually keep paying for physical therapy sessions as long as it is deemed medically necessary. Medicare will cover up to 25 percent of physical therapy work in a skilled nursing facility.
What Will You Have to Pay for Physical Therapy Out of Pocket?
Out-of-pocket costs for physical therapy can be as low as zero in some situations. Original Medicare Part B covers 80 percent of your expenses once you’ve paid the deductible, while you pay 20 percent. Remember that you have the option of Medigap to cover various out-of-pocket costs. With an Advantage plan, you’ll probably pay coinsurance and copays.
Explore Your Coverage Options with Medicare Advisors
Discussing your Medicare for physical therapy needs with an experienced and knowledgeable Medicare expert can save you time and money. Contact us today at Medicare Advisors to learn more about your physical therapy coverage options.