Medicare covers many services and treatments. For example, if you were to have hip replacement surgery, you may wonder whether Medicare would cover the physical therapy. Well, we have your Medicare answers right here! Medicare undoubtedly covers physical therapy, but let’s break down what precisely that coverage looks like for you.
How does Medicare cover physical therapy?
Physical therapy can be a positive course of treatment for Medicare beneficiaries, depending on their health conditions. This service is considered outpatient, which will be covered under Medicare Part B.
There are many different facilities where you can have your sessions too. You can seek treatment from a physical therapist with a private practice, at skilled nursing facilities if you qualify, and at the outpatient department of a hospital. Another option for Medicare beneficiaries is receiving treatment from therapists with rehab agencies.
Is there a limit?
Prior to 2019, Medicare did, in fact, have certain annual limits when it came to these types of services. Thankfully, Medicare no longer has a spending limit for physical therapy sessions, so you don’t have to worry about Medicare not covering the number of medically necessary sessions.
As you’ll find with many other services covered under Medicare, the term “medically necessary” will be the keyword when it comes to receiving coverage. If your healthcare provider deems physical therapy medically necessary for you, it is needed to diagnose, treat, or monitor your health condition.
It would be best if you still kept in mind that although there is no limit on the number of sessions you can have, Medicare can still choose to review whether your physical therapy is still medically necessary to your health.
What are the costs?
Since physical therapy gets covered under Part B, this means Medicare will for 80% of the cost of your sessions. Remember, you must first meet the annual Part B deductible before Part B pays for your outpatient services and treatments. If you do not have any additional coverage, you will be responsible for the remaining 20% Medicare does not cover.
Will my Medigap help pay for it?
If you have Medicare Parts A and B and a Medigap plan, your supplement will help cover the remaining 20% after Medicare pays its 80% for the service.
What if I have a Medicare Advantage plan?
Physical therapy costs will differ under Advantage plans, but you are still covered. Since Medicare Advantage plans must offer the same benefits as Original Medicare, medically necessary physical therapy is included. To see the details of how this service is covered and what your cost-sharing will be, you need to view your plan’s Summary of Benefits. The other factor to keep in mind is that the Advantage plan gets to decide what is medically necessary instead of Medicare.
One critical thing to remember if you have an Advantage plan is you need to ensure the healthcare provider you seek treatment from is in-network and accepts your specific Medicare Advantage plan. Your sessions could get denied, or you could be left with a high bill due to being out-of-network.
Stay on top of it
The main point is that if you need physical therapy, Medicare Part B has you covered so you can focus on getting the treatment you need. As long as the physical therapy is medically necessary and you’re working towards a goal, Medicare should cover it for you. When you pair Original Medicare with a Supplement plan, you may not have any out-of-pocket costs for this service which can leave you stress-free while you heal.