Millions of people need physical therapy services each year, and many of those people are over the age of 65 and Medicare eligible. If you’re over the age of 65 and believe you would benefit from physical therapy, you may be wondering if Medicare will pay for part or all of the service. In today’s blog, we take a closer look at when physical therapy is covered by Medicare, and what financial obligations you may have even if the service is covered.
Medicare For Physical Therapy
Medicare will help to offset the cost of a number of therapeutic services, including physical therapy, occupational therapy, speech therapy and more. However, they won’t just write a blank check for these services and allow you to attend sessions indefinitely. Here’s how it typically works:
For outpatient services, Medicare Part B will cover physical therapy so long as it is ordered by a doctor and deemed medically necessary. The same is true for OT or speech therapy. You can receive these outpatient services at the doctor’s office, at a physical therapy clinic, at an outpatient department and in a rehabilitation or skilled nursing facility. For these outpatient PT services, Medicare Part B will cover 80 percent of the Medicare-approved amount once you meet your Part B deductible, which in 2023 is $226. You will be responsible for paying the remaining 20 percent unless you have supplemental insurance coverage.
A few years ago, there was a cap on how much outpatient therapeutic services a person could pursue each year, but that cap has been removed. With that said, Medicare will require a healthcare provider to confirm that outpatient PT services are still medically necessary if your total costs exceed $2,230 (this amount is the same for occupational therapy and speech therapy).
If physical therapy is recommended by a PT but not officially ordered by a doctor, a physical therapist will provide written notice to Medicare eligible individuals. This notice is called an Advance Beneficiary Notice of Noncoverage (ABN), and it lets the individual know that Medicare may not cover their services, and that if this is the case, the patient is agreeing to pay for services in full.
Inpatient PT Coverage
If you end up needing inpatient physical therapy services at a hospital or inpatient rehabilitation center, Medicare Part A may end up picking up the bill. To be eligible for coverage, a doctor will need to confirm that the patient has a medical condition that requires rehabilitation and coordinated care between doctors and therapists.
We can’t say for certain whether or not you will incur out-of-pocket expenses like a deductible or coinsurance for these situations because it will depend on a few different factors, like treatment setting and length of stay. You can learn more about possible out-of-pocket expenses by checking out this page on Medicare’s website.
We’re more than happy to help you understand your coverage so that there are no surprise expenses down the road, and we can also help you connect with a Medicare representative if they are better suited to answer your questions. We want to be here for you in any way we can, so if you need PT services and are Medicare eligible, let us help you recover. For more information, or to connect with one of our physical therapists, reach out to the team at OrthoRehab Specialists today at (612) 339-2041.