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Does Medicare Cover Physical Therapy?

There are many reasons that people need physical therapy, and knowing whether or not your medical coverage plan helps pay for the costs is essential. In most cases, physical therapy can be an unexpected expense. There are numerous types of therapies that are available, and for people who have Medicare plans, there are a lot of questions. Getting these questions answered is essential when selecting a Medicare plan, as well as when determining your budget.  

One of the requirements for physical therapy to be covered is that it must be medically necessary. This means that it needs to treat a condition or illness, and it also needs to be certified by a doctor as being necessary.  

What Are Medicare Physical Therapy Benefits?


For people obtaining physical therapy through Medicare, there is an annual limit of around $2,000. The limit is also shared with other types of therapies that are covered, so prioritizing may be necessary in some cases. People can apply for a therapy cap exception if they need more than the annual limit. To apply a person needs to go through an exceptions process to determine if additional therapy is medically necessary.


Another benefit that Medicare has is the ability to have physical therapy at home when necessary. If it is medically necessary, a number of home health care services are covered by Medicare Part A. It is essential to know what is covered by each plan, because some people choose to keep their employer-provided health care rather than to purchase Medicare Part B. If this is the case, you may need to look at your employer insurance program to determine what is covered by them and what is covered by Medicare Part A if you have it.


Who Is Eligible For Physical Therapy Under Medicare?


People who have Medicare Part B will have costs covered for the physical therapy so long as the physical therapy services are both reasonable and necessary from a medical standpoint. Services are considered medically necessary if they are needed in order to diagnose or treat a condition or illness. The physical therapy must also meet accepted standards of medicine.


There is a process for getting certified by a doctor for physical therapy services. A doctor must write a prescription for coverage through Medicare Part B. Not everyone is eligible for a Medicare Part B plan, which is important to consider. To be eligible for Part B from Medicare, a person must be 65 years of age or older, as well as meeting at least one additional requirement.


Additional requirements that are considered include receiving security benefits, receiving disability benefits, or having ALS, also called Amyotrophic Lateral Sclerosis.


In addition to Medicare Part B covering physical therapy, people who selects Medicare Advantage, also called Medicare Part C, can be eligible for physical therapy as part of their coverage. This plan covers everything that Medicare Part A and Medicare Part B cover.


How Much Does Physical Therapy Cost Under Medicare?


Medicare covers the costs of approved therapy at 80%. This means that patients pay 20% of the costs for Medicare-approved therapy. The Part B deductible will also apply if the coverage is through Medicare Part B. For people who have a Medicare Advantage plan, also referred to as Medicare Part C, the individual plan that you select will determine your costs. You will need to contact your plan provider for the details, which should also be included in your health insurance literature provided by the company.


What Other Types Of Therapy Does Medicare Cover?


In addition to physical therapy, which is designed to help patients improve balance, strength, flexibility, and other physical abilities, there are other types of therapy that Medicare covers. This includes speech therapy, which treats a wide range of challenges related to speech and people’s voices. This can consist of people who have trouble finding the right words, forming grammatically correct sentences, and using proper volumes. Occupational therapy, which helps people regain the skills needed for daily living, in addition to helping people improve the skills necessary for daily living. This can also be covered by Medicare. This includes therapy for activities like dressing, bathing, skills that are needed to keep jobs, and social skills.