Does Medicare Cover Physical Therapy? What to Know About Coverage

Physical therapy (PT) is a critical component of many medical treatments and rehabilitation programs. It aims to enhance mobility, reduce discomfort, and restore functionality. Physical therapists treat a variety of conditions, including muscle and joint injuries, and neurological illnesses like stroke and Parkinson’s disease.

For U.S. residents requiring physical therapy, understanding Medicare coverage is crucial. While high medical bills can be daunting, Medicare offers some coverage for physical therapy, though there are certain restrictions.

Medicare does not impose a spending limit on physical therapy for beneficiaries. However, if the cost exceeds $2,330, Medicare will only reimburse the service if a doctor certifies it as medically necessary. Here’s when and how Medicare covers physical therapy.

Understanding Medicare Physical Therapy

People often confuse physiotherapy with physical therapy, although they are distinct yet related fields. Physical therapy focuses on exercises to improve balance, strengthen bones, and build muscle mass. In contrast, physiotherapy involves manual treatments like massages and joint manipulations.

Under specific circumstances, Medicare covers both physiotherapy and physical therapy. This article will detail the conditions for physical therapy insurance coverage.

Eligibility for Medicare Physical Therapy Insurance

Are you eligible to apply for the Medicare Physical Therapy Plan? You meet the criteria if you satisfy the following requirements:

• You must prove your citizenship with a Social Security Number (SSN) or identity card.
• You should be 65 years of age or older.
• You should be suffering from a chronic condition affecting bones and muscles.
• A medical practitioner’s prescription for physical therapy is necessary.
• You must be enrolled in Parts A and B of the Medicare program to access the required facilities.

Does Medicare Cover Physical Therapy?

Medicare covers physical therapy, but it is not entirely free. The parts of Medicare that include physical therapy are outlined below:

Part A

Medicare Part A provides hospital insurance and inpatient services like hospital stays and rehabilitation services. It covers hospital care, significant nursing facilities, and in-house stays. If you require physical therapy during an illness or following surgery, consider opting for a Part A insurance plan.

Part B

Part B is typically referred to as medical insurance. It covers all outpatient and preventive services, including visits to registered clinics, even private ones. All types of diagnostic and physical therapy treatments performed with a doctor’s assistance fall under this category. Nursing facilities are available if Part A is not applicable.

Part C

Medicare Part C encompasses all services included in Parts A and B, with additional benefits such as prescription drug coverage and physical therapy. It also offers dental and vision coverage alongside other services.

Part D

While Part D does not directly cover physical therapy costs, it may cover prescribed medications related to physical therapy. This insurance is managed by private organizations under Medicare’s supervision, so verification with your insurer is necessary.

Medigap

Although Medigap does not include physical therapy coverage, it can complement Parts A, B, or C to cover miscellaneous costs. Medigap covers expenses like medication during overseas travel and associated copayments and coinsurances.

The Cost of Medicare Physical Therapy

Medicare covers physical therapy similarly to other medical treatments. As of 2024, after a deductible amount of $2,330, Medicare Part B will cover 80% of physical therapy services. Inpatient or hospital services are available through a deductible or co-payable method, which is easy to follow and access.

Fortunately, Medicare imposes no annual spending limit on physical therapy. However, when expenses reach $2,150, Medicare requires specific verifications regarding your illness and related medical documentation.

Combining Medigap insurance with Part B can reduce your total physical therapy costs to zero, as Medigap compensates the remaining 20% through coinsurance policies.

Benefits of Medicare Insurance for Physical Therapy

Medicare’s coverage of physical therapy offers several unique benefits:

• No referrals are needed to obtain Medicare insurance.
• Medicare provides a unique calculator to estimate annual expenses or costs for specific services, allowing for better financial management.
• Physical therapy can be virtually free with Medigap and Medicare’s basic insurance plans.
• Non-governmental clinics are also considered for treatment under Medicare.

Limitations of the Medicare Program

Medicare will not cover a series of physical therapy sessions until a final treatment plan is established. The program regularly assesses whether the treatment remains medically necessary and if sessions yield the desired results. This evaluation and subsequent communication with Medicare must be conducted by a medical professional like a doctor or physical therapist.

Key components of a Medicare physical therapy plan include:

• A physical therapist assesses the patient’s needs and develops a treatment plan, including suggested therapy duration, types, and objectives, which is then authorized by a doctor.
• Physical therapy services commence, with progress periodically assessed by a physical therapist during this period.
• Upon completing the prescribed sessions, the patient’s progress is reviewed by a doctor and physical therapist. They may decide to discontinue therapy or recommend additional sessions.
• The plan is reviewed by both the doctor and the physical therapist until the patient reaches their treatment objectives or determines that physical therapy is no longer beneficial.