Physical therapy can help restore normal physical functioning and reduce and eliminate various limitations or disabilities caused by disease, injury, or a chronic health condition. Physical therapy can help you maintain your independence and your ability to perform activities of daily living. If you qualify for Medicare due to age or a disability, you may have help covering the costs of physical therapy services that will improve your movement and overall health while reducing the risk of potential injury in the future.
What is Physical Therapy?
There are a variety of different therapy options available to patients, including physical therapy, occupational therapy, and speech-language pathology services. Physical therapy focuses on restoring and increasing joint mobility, muscle strength, and overall functionality. All of these factors play key roles in improving quality of life and affecting the activities and hobbies you are able to participate in.
Physical therapists are able to use their extensive knowledge and training to help your body move better and work more effectively. They have the ability to speed up the recovery process after an injury or surgical procedure and help prevent any further complications.
Do Medicare Benefits Cover Physical Therapy Treatments?
Medicare does offer coverage for all physical therapy treatments that are prescribed by a physician and deemed medically necessary to improve your specific health condition. In most cases, your therapy treatments are covered by Medicare Part B. Part B is responsible for covering medically necessary outpatient procedures and services.
If you do receive your physical therapy at a doctor’s office or other outpatient center, Medicare will cover 80 percent of the Medicare-approved cost. This cost is predetermined by the insurance company as the maximum amount they will pay for a specific service. You will be required to pay the additional 20 percent of the treatment out of pocket. Keep in mind that you will also be responsible for paying your monthly premium and any additional amounts until you reach your deductible.
Individuals can continue receiving physical therapy treatments as often as needed, but if you do reach a certain amount of visits and your total charges exceed $2,000, your physician will be required to submit additional information regarding your health and case-specific details. If Medicare deems your treatment to be medically necessary, your therapy may continue and the insurance will continue to pay 80 percent of the approved amount.
Physical Therapy at Home
If you are homebound and require physical therapy treatments to occur in your own home, you may receive coverage through your Medicare benefits for home health care. Specific requirements must be met to receive home health care, including being homebound and needing skilled nursing services intermittently.
Physical therapy services must be performed by a licensed physical therapist, and regular checkups with your physician must be maintained. If you do receive coverage for home health services and require medical equipment that has been prescribed by your physician, Medicare Part B can help. You will likely pay 20 percent of the Medicare-approved amount for any durable medical equipment you may need, such as wheelchairs, oxygen supplies, or hospital beds, as long as you rent or purchase your equipment through a Medicare-approved supplier that accepts assignment.
Medicare Advantage are required to provide the same Part A and Part B benefits as Original Medicare, but many plans provide additional coverage. Check with your plan for exact costs if you require physical therapy.
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Medicare.org Frequently Asked Questions (FAQ)