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  • Writer's picturePremier One Financial Company

Does Medicare Cover Physical Therapy?

Many people require physical therapy, whether they are recovering from surgery or trying to maintain mobility. However, the cost of physical therapy can add up quickly, especially if treatment is prolonged. As a Medicare beneficiary, you may be wondering whether Medicare pays for physical therapy or not. Find out more below. 


Does Medicare cover physical therapy?

Yes, Medicare Part B covers the cost of physical therapy sessions in outpatient settings such as skilled nursing facilities and rehabilitation agencies. You can also receive physical therapy benefits in the offices of private therapists and outpatient hospital departments. 

However, Medicare doesn’t cover the full cost of treatment. You must meet your Part B deductible. Only then will Medicare pay 80% of the cost while you pay the remaining 20% coinsurance. 


There’s a condition, though. Medicare will only cover physical therapy if a provider deems the service medically necessary. 


What does “medically necessary” mean?

“Medically necessary” means physical therapy is required to diagnose, treat, or monitor a condition. The therapist will provide paperwork that shows the services they are providing and why they are necessary. At some point, Medicare may request a review to ensure the therapy is still medically necessary. 


How do you know Medicare won’t pay for physical therapy?

If your therapy is no longer medically necessary and won’t be covered by Medicare, your therapist must provide a written statement called an Advanced Beneficiary Notice of Noncoverage (ABN). This notice explains why there won’t be coverage and the cost of therapy. This way, you can decide whether to continue therapy and pay out of pocket or cancel. 


Is there a limit on how much Medicare can pay?

Medicare had annual caps on the amount it would pay for outpatient physical therapy services. However, congress removed this limit in 2018. 

While there’s no longer a limit, Medicare requires your therapist to confirm that your physical therapy is still medically necessary once you reach a certain cost threshold. 


Does Medigap cover physical therapy?

After Medicare pays 80% of your physical therapy costs, most Medigap plans can help cover what is left. The type of plan you have will determine whether all or part of the 20% will be covered. 


Does Medicare Advantage cover physical therapy?

Medicare Advantage plans that provide the same benefits as Original Medicare (Part A and B) will also cover physical therapy. However, MA plans are not standardized, unlike Original Medicare. This means coverage and prices can vary from plan to plan; you may pay more or less out of pocket, depending on the specifics of the plan. 


Find the right coverage for your physical therapy needs

Whether you need physical therapy to recover from injury, regain strength after joint replacement surgery, or for other reasons, finding the right plan is crucial. We understand how overwhelming that can be.


As trusted Medicare agents in Lancaster, PA, we can help you find the right coverage for your needs and explain how it will pay for your physical therapy sessions. Contact us today to get started. 

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