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Does Medicare cover physical therapy?

Medicare physical therapy

 

Medicare covers Physical therapy (PT) that is also medically necessary and it will fund the Part B deductible for 80% of your physical therapy costs.

In many cases, physical therapy is necessary for medical problems as well because it emphasizes the restoration of functionality, comfort, and mobility.

Physiotherapists work with you to treat or manage various diseases, including muscular strains, strokes, and Parkinson’s disease.

 

Read on to learn which Medicare benefits cover physical therapy and when.

 

When does Medicare cover physical therapy?

When a service is required to diagnose or treat an ailment or illness, it is deemed medically necessary. Therapy may be necessary to:

  •   Make an improvement
  •   Maintain your current health state
  •   Keep your health as good as possible

 

The healthcare practitioner must be a trained physical therapist or doctor to cover the therapy. Medicare does not cover providing basic exercises for overall fitness.

Before providing you with services that are not covered, a formal notice from your physical therapist is required. After that, you can decide whether or not to use the services.

 

Medicare parts that include coverage for physical therapy:

Let’s review the fundamental aspects of Medicare and how they affect physical therapy.

 

Part A

Medicare Part A covers hospitalization. It includes:

  •   Places such as inpatient facilities
  1. Hospitals
  2. Mental health facilities
  3. Rehabilitation Centers
  4. Skilled nursing facility stay is limited
  •   Hospice services
  •   Inaccessible home healthcare

 

Following hospitalization, Part A will cover inpatient rehabilitation and physical therapy to improve your condition.

 

Part B

Medicare Part B may cover medically essential outpatient services and some preventive care. Medicare-covered physical therapy involves diagnosing and treating illnesses or ailments that impede your ability to function and are also covered by Medicare Part B.

The following locations give these treatments:

  •   Medical offices
  •   Independently employed physical therapists.
  •   Hospitals’ outpatient clinics
  •   Outpatient treatment facilities
  •   Skilled nursing facilities (Medicare Part A do not cover it)
  •   In your abode (using a Medicare-approved provider)

 

Part C

This plan is also called Medicare Advantage (Part C). Part C policies include coverage of Part A and B and this consists of any medically essential PT. Plan-specific therapy service requirements may be found in your Part C plan.

Some benefits, such as dental, vision, and prescription drug coverage, may be covered by Part C plans. This plan varies on account of the program, the business, and location.

Part D

Medicare Part D  provides prescription drug coverage. Medicare-approved private insurance companies offer plans similar to Medicare Part C, and their covered medications may vary.

Part D plans do not cover physical therapy. Prescription drugs, however, may be covered under Part D if they are part of your treatment or recovery plan.

 

Medigap

Private firms sell these plans, which help to cover some uncovered costs. Everything such as

  •   Deductibles
  •   Copayments
  •   Coinsurance”
  •   Medical treatment if you are travelling abroad

 

Particular insurance may help with copayments or deductibles.

 

What does physical therapy cost?

Physical therapy expenses can vary widely, depending on numerous factors, including:

  •   Your insurance
  •   The type of physical therapy you need
  •   The amount of PT or the number of sessions you’ll need
  •   Your physical therapist’s fees
  •   The location of your company
  •   A kind of facility you’re using

 

A copay can impact part of your PT costs. A single session costs $75 in the rarest of situations. If you require frequent physical therapy sessions, this expense may rise.

According to a 2019 survey, the average annual PT spends per participant was $1,488. Joint replacements and genitourinary conditions cost more, while neurological illnesses and vertigo are less expensive.

 

Payment/Coverage

Part B’s deductible in 2021 is $203 and after this Medicare will cover 80% of your physical therapy costs. You will be responsible for the remaining 20% because the whole Medicare cover for physical therapy is no longer available.

Your physical therapist is required to continue providing medical assistance after your total therapy charges reach a certain level and this will be $2,110 in 2021 end.

 

Physical therapists will use documentation to demonstrate the necessity of your treatment. Assessments of your overall health and your progress include detailed information such as this:

  •   Diagnosis
  •   The treatment you’ll be receiving
  •   Your treatment’s long-term goals
  •   A PT session every day or week
  •   Number of physical therapy sessions needed

 

Medical reviews may be performed if total PT costs exceed $3,000 and this review process does not apply to all claims.

 

For physical therapy, which Medicare plans should you choose?

Medicare Part A and B(Original Medicare) cover PT so having these parts is enough if you need them in the next year.

Consider adding a Medigap plan if you’re concerned about expenses that Part A and B do not cover. Also, helping with things like copays is another advantage of physical therapy.

Everything in Part C includes A and B, however, it may cover other types of services. Consider a Part C plan if you will also require dental, vision, or fitness coverage.

The drug coverage in Part D is usually included in Part C plans and can be added to Parts A and B. Explore a Medicare supplement plan if you or someone in your family takes prescription medications.

 

The Takeaway:

Medicare covers outpatient physical therapy when it is medically necessary. There is no limit to the Medicare benefit for physical therapy but it’s necessary to evaluate your needs after passing a certain amount of time.

Part C and Medigap may cover the costs of physical therapy but it’s important to compare a few insurance providers before making a decision.