There are many reasons why you may need physical therapy at some point in your life. Whether that’s recovering from a health emergency like a stroke or heart attack or combatting age-related physical decline by improving flexibility and balance, physical therapy can have amazing effects on your personal well-being and quality of life. But, whatever reason you may have, physical therapy likely won’t fix it after one session. This requires a commitment from you, as well as a financial burden if you don’t have coverage.
With Medicare being such a popular health care solution for millions of seniors in the United States, you may be wondering how physical therapy is covered. Luckily, it is in many cases, though how it’s covered and which part of Medicare covers it depends on the circumstances. Regardless of either of these, the key word for whether it’ll be covered is “medically necessary.” If your doctor signs off that you need the therapy for medical reasons, you’ve already cleared a massive coverage hurdle! After that, we can get into the finer details, like coverage depending on where the therapy is given.
Inpatient Rehab TreatmentIf you’re at an inpatient facility, your physical therapy will likely be covered by Original Medicare as part of your overall treatment. Usually, if you’re receiving physical therapy at an inpatient facility, it’s part of an inpatient rehabilitation care program. To receive coverage for this, your doctor would need to certify that this treatment is medically necessary and that you have a medical condition that requires sustained supervision, intensive rehabilitation, and coordinated care. Similar to other inpatient facilities, Original Medicare should cover your rehabilitation treatment (like physical therapy), meals, skilled nursing care, a semi-private room, medications, and other hospital services and supplies. It will not cover the costs of a phone or television, private nursing care, personal items, or a private room, unless it’s medically necessary.
In terms of what coverage you receive, Medicare Part A is the part you’ll be dealing with. This will be treated like any inpatient facility, and even tack on to a hospital stay that you had immediately prior to your inpatient rehabilitation facility stay. For you, this means that you may not need to pay a deductible at the start of your stay at the inpatient facility, since it would be considered the same benefit period as your hospital stay, where the deductible would likely already have been met. Once you’ve hit your deductible, you’ll pay a daily coinsurance from days 61 to 90. After that, you’ll begin using your lifetime reserve days, which have their own daily coinsurance. In 2020, these costs are:
2020 Part A Inpatient Costs Breakdown
Type of Cost 2020
Inpatient Hospital Deductible
Daily Coinsurance for Days 61 to 90
Daily Coinsurance for Lifetime Reserve Days
Source: Here’s What Medicare Costs in 2020
Outpatient Physical Therapy
Many people who utilize physical therapy services will do so in an outpatient setting. This is when you need the service, but don’t require the supervision or intensive, coordinated care that would make inpatient treatment necessary. Again, your doctor must certify that the therapy is medically necessary to receive coverage. If it is covered, it’ll be covered under Medicare Part B.
Unlike inpatient care, receiving physical therapy in an outpatient setting is pretty straightforward in terms of coverage. You don’t have to add up days, with changing coinsurances depending on which day it is, etc. Instead, Medicare may cover 80 percent of the approved cost for your therapy. The Medicare Part B deductible also will apply for this treatment. Remember, it’s essential that the service is medically necessary to receive coverage, so speak with your doctor before going to get physical therapy.
Your coverage options don’t begin and end with Original Medicare. If you have Medicare Part C, also known as Medicare Advantage, you may get additional coverage on top of what Original Medicare would normally cover. See, Medicare Advantage plans must cover the same services as Original Medicare at the very least, though many go beyond that. The specifics of these benefits depend on your individual plan, so you’ll have to look at yours to know exactly what your coverage is.
Alternatively, you can pick up a Medicare Supplement, which pairs with your Original Medicare coverage. Depending on which Medicare Supplement plan you enroll in, you’ll have different levels of additional coverage. Generally, Medicare Supplements, or Medigap plans, can cover many of your out-of-pocket costs for Original Medicare. This is a great option if you want to keep Original Medicare, but also have extra coverage.
As we said earlier, physical therapy is a commitment that can take months, or even years, to help solve whatever issue causes it to become medically necessary. Ensuring that you’re covered by Medicare can take finances out of the equation and allow you to focus on your health. With the right attitude, physical therapist, and health care coverage, you can reach your health goals.
Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.
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