Many people who receive their Part A and Part B benefits from Original Medicare, the program administered by the federal government, find that they are uncomfortable with the out-of-pocket costs for the medical care. Original Medicare helps cover many costs, but it doesn’t cover everything. Medicare Supplement, or Medigap, policies are sold by private insurance companies to help lower these out-of-pocket costs.
Medicare recipients can choose to enhance their existing Original Medicare benefits with Medicare Supplement plans, like Plan N. Even though the plans are standardized by the federal government, each plan offers different costs and coverage.
When Do You Need Physical Therapy?
Your doctor may refer you to a physical therapist for a variety of reasons. The most common issues involve lower back pain or issues with mobility that can be remedied with a targeted physical therapy treatment plan. The goal for most physical therapy treatment plans is to not only improve a person’s condition, but to help them prevent injuries from occurring or the pain associated with an existing injury from worsening.
Neurological conditions that impact how the body moves can also require the support of a physical therapist. Other chronic conditions, such as arthritis or diabetes, can lead to secondary mobility or pain management issues that benefit from physical therapy techniques. Even simpler issues, such as strained or sprained muscles, can fall under the spectrum of a physical therapist’s work.
Ultimately, you and your primary care physician will determine if your circumstances can be improved by working with a physical therapist on an effective treatment plan.
Differences Between Medigap and Medicare Advantage Plans
Both Medicare Supplement and Medicare Advantage plans work to expand or enhance the benefits Original Medicare recipients enjoy. They are also both offered through private insurers who are contracted by Medicare to offer some or several plan options.
Where they differ is how they work with Original Medicare to provide these benefits. Unlike a Medicare Advantage plan, a Medicare Supplement plan does not bundle Part A and Part B benefits into its own plan. A Medicare Supplement plan stands alone from Original Medicare Part A and Part B, but a recipient must have both Original Medicare coverage in order to enroll in a Medicare Supplement plan.
Medicare Supplement plans are also standardized across the nation, whereas what’s offered by any given Medicare Advantage plan is determined by the private insurer. This means that a supplement plan, like Plan N, will offer the same benefits no matter which insurer carrier offers it.
Medicare Supplement plans do not offer extra benefits like vision, dental or prescription drug coverage. Medicare Supplement plans help cover what Original Medicare does not, such as copayments, coinsurances and deductibles. Anyone who enrolls in a Medicare Supplement plan can also enroll in a stand-alone Part D Prescription Drug Plan, but they cannot enroll in a Medicare Supplement plan and a Medicare Advantage plan at the same time.
Medigap Plan N Coverage for Physical Therapy
Because Medicare Supplement plans work with existing benefits for Original Medicare recipients, anything that falls under Part A or Part B coverage terms is applicable under Plan N. For Part B outpatient physical therapy, it must be deemed as medically necessary and Medicare may require documentation to show why the treatment is needed and for how long.
While Plan N does not cover the Part B deductible, it does cover copayments and coinsurances with the exception that some office visits may incur a $20 copayment. Your plan representative can help you understand when this copayment may be required.