If you’ve recently signed-up for Medicare, you might be wondering, “Does Medicare cover physical therapy?”
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Here’s a quick summary of the physical therapy (also called physiotherapy) costs you can expect to pay when covered by Medicare.
The two parts of Medicare coverage
First, there are two main parts of Medicare coverage: Part A and Part B.
Medicare Part A covers your monthly premium for hospital insurance. Part A covers inpatient hospital care, hospice, home health care, as well as any lab tests or surgery you might need (such as knee or hip replacements).
Medicare Part B covers the premium for your medical insurance, including services deemed medically necessary or preventative. In other words, Part B covers visits to your Medicare doctor or other health care provider, medical equipment, ambulance services, mental health services and limited outpatient prescription drugs.
Now, will Medicare cover physical therapy?
The short answer: yes. Since Medicare Part A covers inpatient services relating to hospitalization, it would pay the cost of physical therapy.
When needed, outpatient physical therapy is partially covered by Medicare Part B, as well as speech-language pathology and occupational therapy. That means that once Medicare approves the service amount, and the deductible is met, you would pay 20% of the therapy expenses and Medicare pays the rest.
But that’s not all. Here are a few frequently asked questions:
Do I need a referral for Medicare to cover physical therapy costs?
No, you do not need a referral for Medicare to cover visits to a physical therapist.
What is the Medicare deductible for physical therapy?
The deductible for your Medicare Part A is $1,556 and the deductible for Medicare Part B is $233 per year. You can find out more about that on the Medicare website.
How many physical therapy sessions will Medicare cover?
Once a provider prescribes physical therapy, Medicare Part B will pay for all medically necessary outpatient physical therapy. If your physical therapy isn’t deemed medically necessary, then you will need to pay the full amount.
Is there a physical therapy cap?
There is no cap for what Medicare will cover. However, after spending $2,150 for physical therapy, speech-language pathology and occupational therapy, Medicare does require the provider to verify the medical necessity of the therapy.
We recognize that sometimes, circumstances make it difficult to pay for medical bills. In some cases, you may be eligible for Medicare Savings Programs.
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To learn more about Medicare, visit Medicare.gov. As you approach age 65, consider a Medicare provider that focuses on caring for seniors. Partner providers listed on NewPrimaryCare.com understand the importance of delivering personalized care for those with chronic conditions, complex medication schedules and difficulty leaving home.
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