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Rehabilitation is never easy. Shot of a physiotherapist helping a senior man with weights.

Does Medicare Cover Physical Therapy?

Isaac Newton’s first law of physics is that a body in motion stays in motion. That is true in many areas of life, but it is especially true for our bodies as we age. Our bodies can become weaker and stiffer, making it harder to do everyday activities. Or maybe you have been in an accident or just had surgery. 

In both instances, physical therapy can get you back on your feet again! It can help seniors get stronger, feel less pain, and keep their balance to avoid falls. 

Does Original Medicare cover physical therapy? Do you need a referral? Does it matter if you’re at home or in a facility? This article will answer all of these questions and more. 

Understanding Physical Therapy and Its Types

Physical therapy is a type of healthcare that helps people move and feel better. It’s like exercise with the help of a special therapist. The therapist uses different exercises, gentle touches, and special tools to help with pain, injuries, and other body problems.

There are different types of physical therapy for different needs:

  • Orthopedic Physical Therapy: This helps with muscle and bone problems like joint pain or broken bones.
  • Neurological Physical Therapy: This type is for people who have problems with their brain or nerves, like after a stroke or spinal injury.
  • Geriatric Physical Therapy: For older adults, this therapy can help with issues like arthritis and problems with balance.
  • Cardiovascular and Pulmonary Physical Therapy: This helps people with heart and lung conditions to breathe better and have more energy.
  • Sports Physical Therapy: For active seniors, this type helps with injuries and getting back to doing sports safely.
  • Aquatic Therapy: This is done in a pool, which is great for people with joint problems or difficulty walking.

Physical therapy is helpful for people of all ages, and it can make them healthier and stronger. Now, with Medicare, can you get this therapy covered to help with your health needs?

Does Original Medicare cover physical therapy? 

Yes, Original Medicare does cover physical therapy! This includes aqua therapy, speech therapy, and occupational therapy. 

Medicare Part A will cover the cost if you receive physical therapy during or after a hospital stay. However, if you get physical therapy as an outpatient or at home, Medicare Part B will pay for it. 

Does Medicare cover physical therapy at home?

Medicare can cover the cost of physical therapy at your home under certain conditions. To be eligible, you must:

  • be under a doctor’s care, 
  • need to improve or maintain your current physical condition, and 
  • your doctor must certify that you are homebound. 

Medicare can also help with the cost of durable medical equipment.

Do I need a referral for physical therapy? 

Yes. Medicare will only cover physical therapy if a doctor refers you because it is medically necessary.

How much does physical therapy cost under Original Medicare? 

If you have original Medicare, Part A covers 100% of the physical therapy cost after you meet the annual deductible of $1,600 in 2023. This coverage applies to inpatient services in a hospital, nursing facility, or at home after a 3-day hospital stay. 

The 100% coverage lasts for the first 60 days of inpatient services, and after that, you may need to pay daily coinsurance fees or a fixed amount for additional days. Medigap plans can help reduce out-of-pocket costs, as they cover Part A hospital coinsurance and, in many cases, the deductible.

Medicare Part B covers 80% of outpatient physical therapy after you pay the Part B deductible of $226 in 2023. The remaining 20% can be an out-of-pocket expense or covered by another plan, such as your Medicare Advantage plan. 

Is there a limit to the number of sessions Medicare will cover?

Does Medicare Cover Physical Therapy - Rehabilitation is never easy. Shot of a physiotherapist helping a senior man with weights.

In the past, Medicare used to pay physical therapists based on how many times they saw patients and how long each visit was. But things have changed. Medicare has adopted a new approach called “value-based” payment. This means they consider what each patient really needs and use a complex formula to figure out the best way to pay for it.

Doctors can now approve up to 30 days of physical therapy at a time. If you need more therapy beyond those 30 days, your doctor will need to give their approval again.

The good news is that Medicare doesn’t limit the number of physical therapy sessions you can have in a year anymore. This means you can get as much therapy as you truly need. However, if the total cost of your physical and speech therapy combined reaches $2,150, Medicare will review your case before continuing to cover additional services.

Physical therapy coverage under your Medicare Advantage or Medigap plan

Since your Medicare Advantage covers, at the very least, the same benefits as Original Medicare, you can expect your plan to cover physical therapy. However, the costs and coverage may vary depending on your policy. For example, you must likely stay in-network for the best coverage.

If you have a Medigap plan, it could cover your out-of-pocket costs for physical therapy. Depending on your Medigap plan, you may receive full coverage, which can be beneficial if you anticipate needing physical treatment frequently.

Making the right moves with The Medicare Family

In conclusion, physical therapy can be a crucial and effective tool for seniors to improve their mobility and overall well-being. Whether you’ve experienced an accident, had surgery, or want to stay active, physical therapy can help you get back on your feet and enjoy a better quality of life. Thankfully, Medicare covers physical therapy under certain conditions, whether you receive treatment in a hospital, at home, or in a facility. 

Working with The Medicare Family can ensure you choose the right coverage and understand the available options. We have been guiding seniors in their Medicare choices for over 40 years. So, don’t hesitate to explore the benefits of physical therapy and find the Medicare plan that suits your needs best with the help of The Medicare Family. 

Book your complimentary consultation here to get started.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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