Does Medicare Cover Physical Therapy?

What is physical therapy and why is it so important for seniors?

Physical therapy is an important part of recovery for many seniors after undergoing an injury or surgery. This vital healthcare specialty includes the well-rounded evaluation, assessment, and treatment of individuals who deal with physical limitations as a result of illness, disability, surgery, or injury. 

The primary goal of a physical therapist is to increase functional mobility through proven exercises and activities. Very few, if any, of these exercises are intensive, however, as the intended effect is to restore one’s ability to move and function on their own, not just to maximize strength and endurance.

Physical therapy sessions have been proven to help seniors recover more quickly and safely following injuries or surgeries, but of course, this begs the question: does Medicare cover physical therapy? To get to the bottom of this question, let’s break it down in more detail.

Does Medicare pay for physical therapy?

You may be pleasantly surprised to learn that Original Medicare will, in fact, pay for at least a portion of physical therapy visits that are considered to be medically necessary by a patient’s doctor. For example, a physician may prescribe physical therapy as part of the treatment plan for a chronic condition like Parkinson’s disease or to aid in recovery after one sustains a fall, a stroke, or undergoes invasive surgery. 

In this scenario, Medicare Part A (the “hospital insurance” portion of Original Medicare coverage) or Medicare Part B (the “outpatient treatment” portion of Original Medicare) may cover physical therapy services depending on the circumstances and the setting.

Physical Therapy Coverage Under Medicare Part A

Under Medicare Part A, most, if not all, of the cost of physical therapy treatment you receive while admitted to an inpatient rehabilitation facility will be covered. Other needs may also be partially covered under Medicare Part A, such as services received at a skilled nursing facility.

Physical Therapy Coverage Under Medicare Part B

Under Medicare Part B, certain outpatient physical therapy needs may also be covered, including:

• Physical therapy sessions at a doctor’s office or physical therapist’s office
• Physical therapy received in some outpatient hospital departments
• Physical therapy administered at an outpatient rehabilitation facility
• Physical therapy visits conducted at skilled nursing facilities if you are considered an outpatient
• Physical therapy at home that is provided by a Medicare-certified health agency

What are some out-of-pocket costs that may be associated with outpatient physical therapy even with Medicare?

For outpatient physical therapy services, you will be responsible for 20 percent of the Medicare-approved amount of the service you receive. For Medicare Part B coverage, the Part B deductible does apply, meaning Medicare will pay its share once you have met your deductible for the year.

At one time, Medicare would set an annual maximum for what it would pay for outpatient therapeutic services, but this cap was legally eliminated in 2018. 

You may be asking yourself, “how many days of physical therapy does Medicare cover?” If so, please note that a doctor is authorized to prescribe up to 30 days of physical therapy at a time. After 30 days, the patient must be re-evaluated to determine if there is a need for additional 

Keep in mind, however, that even if you have Medicare insurance, a treatment that is not recommended as medically necessary by a doctor or physical therapy provider will not be covered. Choosing to proceed with therapy that is not ordered by a doctor will result in your responsibility for the full cost of the services you receive.

How can I get even more comprehensive Medicare coverage for my specific healthcare needs?

The simple answer to the question “does Medicare cover physical therapy?” is yes, with conditions. That said, did you know that it may be possible to enroll in a Medicare plan that offers even more comprehensive healthcare coverage than Original Medicare?

These plans, known as Medicare Advantage plans, or Medicare Part C plans, are legally required to provide the exact same level of coverage as Original Medicare, but they also offer additional benefits at a more affordable, bundled price. 

Some Medicare plans may even cover portions of physical therapy visits or physical therapy sessions that Original Medicare does not. Please note, however, that Medicare Advantage plans are offered by private insurance companies. As a result, their availability, pricing, and exact benefits can vary from plan to plan and from provider to provider.

Luckily, the experienced, friendly, and licensed insurance agents at MedicareInsurance.com will be more than happy to assist you in exploring and comparing all of your potential Medicare options. Simply give us a call today at (800) 950-0608 to get started!