- What Is Physical Therapy?
- Does Medicare Cover Physical Therapy?
- Medicare, Physical Therapy, and Inpatient Facilities
- Medicare, Physical Therapy, and Outpatient Facilities
- Does Medicare Advantage Cover Physical Therapy?
- Do Medigap Plans Cover Physical Therapy?
- Other Options for Pain Management Covered by Medicare
Physical therapy, also known as “PT” for short, is a type of physical rehab that can help reduce pain, improve mobility, and more.
Medicare covers physical therapy if it is a medical necessity for the patient. Depending on where the PT is administered will dictate which portion of Medicare will pay for the PT sessions.
Physical therapy, sometimes called “PT” for short, is a type of physical rehabilitation that helps with a multitude of health problems related to how the body moves and functions physically. It can help improve a patient’s quality of life and enhance one’s mobility as well as reduce or improve pain.
Medicare covers physical therapy sessions so long as they are deemed medically necessary. There is no therapy cap on how much Medicare will cover for PT. That said, there are specifics involved for how much it will cost.
This resource will explain everything Medicare beneficiaries need to know about Medicare and physical therapy, including how Medicare coverage works, costs, and more.
What Is Physical Therapy?
Physical therapy, also known as physiotherapy, is a specialty type of health care that focuses on the movement and mobility of its patients. There are a number of physical therapy types that serve different areas of the body such as geriatric, orthopedic, and neurological.
Treatment goals of PT include addressing functional limitations, aiming to improve or restore damaged sensory or motor function.
Note: Learn more about physical therapy at this resource.
What Are Physical Therapists?
Physical therapy is administered by a health care provider known as a physical therapist. Physical therapists can both evaluate and treat various mobility and functional impairments of the body.
In order to be a physical therapy provider, interested persons must have a Doctor of Physical Therapy degree from a Commission on Accreditation in Physical Therapy Education-accredited physical therapist education program. They must also pass a state licensure exam.
Note: Learn more about physical therapist qualifications at this resource.
Physical Therapy Benefits
The benefits of physical therapy are manifold. Some such benefits include, but are not limited to:
Reduces the need for opioids
Enhances mobility and movement
Aides injury recovery
Improves quality of life
Note: Learn more about the benefits of physical therapy at this resource.
How Much Does Physical Therapy Cost Without Health Insurance?
Without health insurance, physical therapy sessions can range from $100 to as much as $250 per session. Insurance plans, such as Medicare plans, can help offset the often high cost of physical therapy.
Does Medicare Cover Physical Therapy?
Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A covers inpatient services while Medicare Part B covers outpatient services and preventive care such as vaccinations.
Physical therapy can be performed in both outpatient and inpatient settings. Depending on where the PT takes place will dictate which portion of Medicare will pay for the physical therapy services.
Medicare, Physical Therapy, and Inpatient Facilities
Medicare Part A covers inpatient physical therapy within skilled nursing facilities as well as inpatient rehabilitation facilities. How coverage functions will depend on the type of inpatient facility.
What Are Skilled Nursing Facilities?
Skilled nursing facility (SNF) care is administered in skilled nursing facilities. Part A covers SNF care on a short-term basis if certain conditions are met:
The patient is enrolled in Part A
The patient has remaining days in their benefit period
The patient has a qualifying hospital stay
The patient’s doctor has assessed a need for daily skilled care (i.e. care administered, or supervised, by skilled nursing or therapy staff)
The skilled nursing facility is Medicare-approved
The medical condition that requires skilled care must also meet a number of conditions. More information regarding the specifics and costs is available at this resource.
What Are Inpatient Rehabilitation Facilities?
An inpatient rehabilitation facility is an inpatient care unit to aides a patient’s recovery from medical events such as a serious surgery, illness, or injury that require an intensive rehabilitation therapy program, physician supervision, and coordinated care from all parties involved.
Like skilled nursing facilities, rehabilitation centers are covered by Medicare Part A. Costs will vary depending on the benefit period a patient is in and how long they stay. Learn more about Medicare, inpatient rehabilitation care, and its costs at this resource.
Medicare, Physical Therapy, and Outpatient Facilities
Medicare Part B covers medically necessary physical therapy within outpatient settings. In order for a health care service, such as various types of outpatient therapy, to be deemed medically necessary, Medicare requires specific documentation.
Outpatient Physical Therapy Costs
Medicare beneficiaries should expect to pay 20% of the Medicare-approved amount with Medicare covering 80% of that amount.
In order for an individual to have Part B coverage, they must pay the Part B monthly deductible. In 2022, the Medicare Part B deductible is $233 per month.
Under Medicare law, there are no longer coverage limits on how much Medicare pays for medically necessary outpatient physical therapy sessions annually.
Note: Learn more about outpatient physical therapy and Medicare at this resource.
Does Medicare Advantage Cover Physical Therapy?
Medicare Advantage plans, also known as Medicare Part C or MA plans, are supplemental insurance plans contracted through private insurance companies that are Medicare-approved. MA plans bundle Medicare Part A and Medicare Part B together. Many Medicare Advantage plans also include prescription drug coverage.
Because a Medicare Advantage plan combines both Part A and Part B, an MA plan will cover physical therapy services the same way as Original Medicare. As a reminder, Part A covers inpatient PT while Part B covers outpatient PT.
That said, costs will vary based on the specific Medicare Advantage insurance plan. Beneficiaries should always consult their insurance company to confirm coverage and what costs they would be responsible for out-of-pocket.
Do Medigap Plans Cover Physical Therapy?
A Medigap plan is a type of Medicare supplement insurance. This Medicare supplement plan helps “fill the gaps” of Original Medicare by helping pay out-of-pocket costs, such as Medicare Part B’s yearly deductible.
Since Medicare Part B is responsible for outpatient physical therapy, Medigap plans that cover Part B’s deductible would help pay for physical therapy performed in an outpatient setting.
That said, not all Medigap plans cover annual deductibles, coinsurance, or copayments. Beneficiaries should always do their research prior to enrolling in a Medigap plan to confirm extra benefits.
Other Options for Pain Management Covered by Medicare
Medicare and physical therapy are just one component of pain management services covered by the healthcare program. Other Medicare-covered services for pain management include:
Individual and group therapy
Note: Learn more about Medicare and health care services for pain management at this resource.