Does Medicare Cover Physical Therapy?
Medicare insurance covers physical therapy, along with other outpatient therapy such as occupational therapy and speech language pathology. There is no cap on how much you can spend on therapy, but the treatment must be medically necessary or you could end up paying out of pocket.
Who is eligible for physical therapy under Medicare insurance?
If you have Medicare Part B your physical therapy costs will be covered—as long as Medicare finds the treatment medically necessary.
Medicare considers physical therapy treatment medically necessary if it meets the following requirements:
- Therapy is needed to diagnose or treat an illness or condition.
- The treatment meets accepted standards of medicine.
- Your doctor confirms therapy is necessary to treat your condition.
Most people who qualify for Medicare Part B insurance do so based on their age of 65 older. But you could also qualify if you meet at least one of the following requirements:
- You are disabled and have received Social Security Disability Income for two years.
- You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
- You have End-Stage Renal Disease (ESRD).
Learn more about who qualifies for Medicare.
Medicare Advantage plans also cover physical therapy, since they are required to cover everything Medicare Part A and Part B cover. There may be additional benefits with some Medicare Advantage insurance plans, and your costs may differ from Original Medicare. So be sure to double-check your plan’s details with your insurance provider.
How much does physical therapy cost under Medicare insurance?
Patients pay 20% of the Medicare-approved amount for therapy. However, if your physical therapist charges more than the Medicare-approved amount for treatment, you must pay the difference.
Since these services are covered under Part B, the Part B deductible also applies. In 2020, the Part B deductible is $198 per year (up from $185 in 2019).1 That means you’ll need to pay $198 out of pocket each year before Medicare will start paying its portion of the costs.
If you have a Medicare Advantage plan instead of Original Medicare insurance, your costs will depend on the specific plan you select—you can contact your plan provider for details.
Does Medicare cover physical therapy at home?
Yes, Medicare will cover physical therapy at home if it is medically necessary. Medicare covers a variety of home health care services, including physical therapy, although they are usually covered under Part A rather than Part B.
To qualify for home physical therapy treatment, you must be home-bound or have difficulty leaving your home to get to an in-office appointment.
What other types of therapy does Medicare cover?
Medicare insurance covers several types of therapy:
- Physical therapy: This therapy is designed to help the patient improve balance, strength, flexibility, and other areas of physical ability. Physical therapy might be used after an injury or surgery to help the patient regain normal functionality.
- Occupational therapy: Occupational therapy focuses on helping people improve or regain skills necessary for everyday activities. This is a broad category of therapy and includes therapy for activities of daily living like bathing. eating, and dressing; skills needed to get and keep a job; and social skills.
- Speech therapy: Also known as speech-language pathology, speech therapy treats a wide range of speech and voice challenges, including trouble finding the right words, creating meaningful and grammatically correct sentences, and using the proper volume when speaking.
What if Medicare won't cover all my physical therapy?
Medicare no longer caps how much medically necessary physical therapy it will cover throughout the year. But in some cases, doctors might recommend physical therapy beyond what Medicare considers medically necessary. In this case, you may be stuck paying for additional treatment sessions out of your own pocket.
To help pay these costs, you could turn to Medicaid, which helps some low-income people, pregnant women, and families cover their health care costs.
Otherwise, consider switching from Original Medicare to Medicare Advantage. Many Medicare Advantage plans cover more services than Original Medicare, so you could find a plan that pays for more physical therapy.
Learn more about the differences between Original Medicare and Medicare Advantage.
Sources
- Medicare.gov, “Part B Costs”
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