How Many Physical Therapy Sessions Does Medicare Cover
Medicare does not limit the number of physical therapy sessions you can receive and covers outpatient therapy for as long as you need it. But there is a maximum benefit for inpatient therapy depending on where you receive services. For instance, after 151 days at an inpatient rehab facility, you pay for all charges, including physical therapy. When you receive care at a skilled nursing facility, you pay the cost of all services beginning on day 101.
How Long Will Medicare Cover Rehab In An Inpatient Rehabilitation Facility
Medicare covers inpatient rehab in an inpatient rehabilitation facility also known as an IRF when its considered medically necessary. You may need rehab in an IRF after a serious medical event, like a stroke or a spinal cord injury.
To qualify for care in an inpatient rehabilitation facility, your doctor must state that your medical condition requires the following:
The costs for rehab in an inpatient rehabilitation facility are as follows:
- You usually pay nothing for days 160 in one benefit period, after the Part A deductible is met.
- You pay a per-day charge set by Medicare for days 6190 in a benefit period.
- You may use up to 60 lifetime reserve days at a per-day charge set by Medicare for days 91150 in a benefit period.
- You pay 100 percent of the cost for day 150 and beyond in a benefit period.
Your inpatient rehab coverage and costs may be different with a Medicare Advantage plan, and some costs may be covered if you have a Medicare supplement plan. Check with your plan provider for details.
Your costs may also be different if you were transferred to an inpatient rehab facility either directly from an acute care hospital or within 60 days of being discharged from a hospital. In these situations, you wont have to pay a deductible for the care you get at the inpatient rehab facility if you already paid a deductible for the prior hospitalization in the same benefit period.
What Are Medicare Physical Therapy Benefits
Generally speaking, Medicare helps pay for any medically necessary physical therapy services your doctor orders to treat your condition. However, your Medicare physical therapy benefits depend, in part, on where you get services.
Medicare Part B generally covers physical therapy services. If you get physical therapy at the hospital, an outpatient center, or in your doctorâs office, Part B typically covers 80% of allowable charges after you meet your Part B deductible. These benefits are the same for other medically necessary therapies such as occupational therapy and speech language therapy.
However, if you need physical therapy services at home, your Medicare Part A and/or Part B home health benefits may cover 100% of the allowable charges. In order to get Medicare physical therapy benefits at home, you must meet all of the following conditions:
Medicare physical therapy benefits generally wonât cover home health services that are more than part-time or intermittent in nature.
If you qualify for physical therapy home health care, you pay nothing for your therapy, and just 20% of the allowable charges for any durable medical equipment you may need as part of your treatment.
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Medicare Supplement Insurance And Physical Therapy
Medicare supplement insurance will cover the majority of your out-of-pocket costs for physical therapy. But which plan is the best? That depends on your budget and your needs. The best Medicare plan for physical therapy provides the following benefits:
- Your Part A coinsurance
- Your Part B coinsurance
- Part B deductible
Since all 10 plans cover these expenses to some degree, you are free to choose the plan that suits you best based on other factors. For many beneficiaries, the most important thing is an affordable monthly premium. And we can show you how to find it .
Regaining Strength And Motion
After a knee replacement, exercising to regain strength and range of motion is crucial. Most patients begin to stand and walk using a walker within hours after surgery. Your physical therapy program will start with gentle exercises to help you bear weight on your new joint. Performing range of motion exercises after surgery is especially important to prevent scar tissue from limiting the flexibility of the new joint. You will also be taught how to manage pain after surgery. Some pain after a knee replacement should be expected.
Most rehabilitation programs for knee replacements usually include range of motion exercises, quadriceps strengthening, gait training and daily life training exercises. Its important to avoid straining or overworking the knee during your recovery period. Healing takes time and you shouldnt try to rush your rehabilitation.
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What Other Types Of Therapy Does Medicare Cover
Medicare insurance covers several types of therapy:
- Physical therapy: This therapy is designed to help the patient improve balance, strength, flexibility, and other areas of physical ability. Physical therapy might be used after an injury or surgery to help the patient regain normal functionality.
- Occupational therapy: Occupational therapy focuses on helping people improve or regain skills necessary for everyday activities. This is a broad category of therapy and includes therapy for activities of daily living like bathing. eating, and dressing skills needed to get and keep a job and social skills.
- Speech therapy: Also known as speech-language pathology, speech therapy treats a wide range of speech and voice challenges, including trouble finding the right words, creating meaningful and grammatically correct sentences, and using the proper volume when speaking.
How Do Different Health Insurance Plans Cover Physical Therapy
Whether or not your health insurance plan covers physical therapy costs depends on several factors.
A major factor is the type of health plan you have. For example:
- Employer-sponsored or job-based policies are more likely than most kinds of health insurance policies to pay for physical therapy.
- Individual health insurance policies, especially ones that are bought from the federal or state marketplace, often cover physical therapy, too. But they dont always cover it well.
- If youre on Medicare, youre in luck. Medicare Part B covers many forms of physical therapy to an extent.
- People on Medicaid arent as lucky. Federal law treats physical therapy as an optional benefit in terms of this program. That means states can choose to cover it or not. Some do, but many dont.
Keep reading to learn more about how these different health insurance plans do and dont cover physical therapy.
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Get The Physical Therapy You Need
You no longer have to ask: How do I find a physical therapist who takes Medicare near me? At Moving With Hope, we accept Medicare. Furthermore, we provide affordable physical, occupational, and speech-language therapy sessions.
We leverage the best and most experienced healthcare professionals, adaptive exercise, evidence-based research, and innovative equipment to give you the long-term support that you need. Moving With Hope empowers survivors, strengthens communities, and gives hope. Contact us today to find out how we can serve your physical therapy requirements.
Is There A Limit On What Medicare Pays For Physical Therapy
In 2018, congress eliminated the limits on how much Medicare pays for therapy services in a single year.
This means that in qualifying cases, Medicare Part B will continue to help cover some of the costs of your physical therapy, no matter how high your accumulated costs grow in the year.
Your therapy provider may need to add a notation to your therapy claim, confirming that your therapy services are reasonable and necessary. Your therapist may also add information to your medical records explaining why the services are medically necessary.
If your physical therapy services are not medically necessary, your therapy provider must provide you with a written notice before providing services.
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Does Medicare Cover Other Types Of Therapy
In addition to physical therapy, Medicare also covers speech therapy and occupational therapy.
- Speech therapy, or speech-language pathology, helps treat speech and voice challenges. This may include help finding the right word, using proper voice volume, and creating meaningful sentences.
- Occupational therapy helps you improve skills you need for everyday activities. This may include eating, bathing, getting dressed, etc. It may also include social skills or skills necessary for employment.
Is Physical Therapy Covered At Home
If you are receiving at-home physical therapy services, they may be 100 percent covered by either Medicare Part A or B depending on whether or not:
- You are under a doctors care, and physical therapy is part of your care plan
- You are certified home-bound by your physician
- The physical therapy treatments are performed by a qualified physical therapist
- The home health agency providing the physical therapy services is certified by Medicare
- Your doctor expects you to improve due to physical therapy
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Understanding Physical Therapy Services
Physical therapy is a proven form of health care that:
Reduces chronic pain
Treats injuries and other kinds of movement problems
Helps minimize the need for surgery
Allows many patients to avoid prescription drugs
Is often tailored to patients’ individual needs, and is a collaboration between physical therapists and patients
Physical therapy addresses a wide range of physical ailments, from Achilles tendon injuries to the symptoms of vertigo. And because it serves as an alternative to surgery, physical therapy can be a lower-cost health option for those suffering from pain.
What Are Medicare Physical Therapy Services
According to the Alliance for Physical Therapy Quality and Innovation , physical therapy helps people with injury, chronic pain, and people who have problems moving. Physical therapy can:
- Improve balance
- Help manage arthritis and joint pain
- Improve cardiovascular function and manage chronic diseases such as diabetes and heart disease
- Reduce the need for opioid pain medication
The APTQI reports that physical therapy may also lower Medicare spending under Part A and Part B. For patients who had surgery, Medicare spending was 75% lower than total average spending for those who received Medicare physical therapy services during recovery.
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What Should I Consider In Knee Surgery Cost After I Am Discharged From The Hospital
You may be sent home with prescription medications to manage pain, and reduce the risk of blood clots or infection. You will probably have one or more follow-up appointments with your surgeon. You may also need physical therapy or other rehabilitation services for a few weeks after the procedure.
Although there is generally no coverage under Original Medicare for prescription medications you take at home, Part B typically pays 80% of allowable charges for all medically necessary doctor visits and physical or occupational therapy services you need after your surgery. Part B usually also generally covers durable medical equipment such as a cane or walker if your doctor orders one for you to use during your recovery. Its a good idea to discuss your after-surgery care with your doctor so you know what to expect and can better plan for your out-of-pocket expenses.
In some cases, your doctor may recommend a brief stay in a skilled nursing facility after your knee replacement. In order to be eligible for Part A skilled nursing facility coverage, you must have a qualifying hospital stay of at least three days prior to your admission. If your stay is covered, you pay nothing for the first 20 days of skilled nursing facility care there is a daily coinsurance amount applied to days 21 and beyond.
Therapy At An Office Or Facility
For therapy received in a doctor’s or therapist’s office, a rehabilitation facility, or a skilled nursing facility while you’re an inpatient, Medicare will pay 80% of the Medicare-approved amount. You or your supplemental medigap insurance or Medicare Advantage plan are responsible for the other 20%.
There are limits on the total amount Medicare will pay for therapy in these settings. These limits are called “therapy caps.” Medicare will pay up to $1,880 per year for outpatient physical therapy and speech-language pathology . There is a separate cap of $1,880 for occupational therapy. However, you might be able to qualify for an exception so that Medicare will continue to pay for therapy after you reach the cap.
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What Are Medicare Physical Therapy Benefits With Medicare Advantage Plans
If you have a Medicare Advantage plan, your Medicare physical therapy benefits may be slightly different. Medicare Advantage plans must provide the same level of benefits as Original Medicare, at a minimum. However, because these plans are offered by private insurance companies, they are free to offer extra benefits in addition to those under Part A and Part B. If you have a Medicare Advantage plan, check with your plan administrator or your plan documents to see how it covers physical therapy.
Do you have any questions about Medicare physical therapy? Feel free enter your zip code on this page to browse Medicare plan options in your area.
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Can You Get Therapy At Home
Most people will drive to an office or facility to complete their therapy sessions but some people may not have the means to get out of the house. In these cases, home therapy may be covered by Medicare.
The first requirement is that you be homebound to receive home health services. According to Medicare, this means that you are unable to leave your home without help, leaving your home is too physically taxing or your medical condition is too serious to recommend you leaving the home. It is not simply a transportation issue.
The second requirement is that therapy be performed by a qualified professional who will “safely and effectively” establish a program that will improve or at least maintain your condition. Generally speaking, services are not intended to last forever but should span a reasonable period of time to achieve the intended goal.
People on Medicare Advantage plans may have another option. As of 2019, some Medicare Advantage plans may be offering ride shares as a supplemental benefit. This could improve access to physical therapy and occupational therapy outside of the home for people who do not otherwise have the means to travel to their appointments.
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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.
Medicare Supplement Plans And Physical Therapy
Your Medicare Supplement policy could cover your out-of-pocket physician therapy costs. Depending on the Medicare Supplement plan, you could receive full coverage. Those who anticipate needing physical therapy should consider Medigap to keep their costs as low as possible.
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To better explain how Medigap could benefit someone in need of physical therapy, lets look at an example. Suppose Josie needs physical therapy for her knees. She enrolled in Medicare Supplement Plan G because she knows she needs to visit the doctors office frequently.
Since Josie has Medigap Plan G, she will pay her premium and the Medicare Part B deductible. If Josie has inpatient physical therapy, she will not pay anything other than her monthly premium.
But, with outpatient physical therapy, Josie will need to pay the Medicare Part B deductible. If Josie did not have Medigap, she could be responsible for deductibles and coinsurance.
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Find Medicare Advantage Plans That Cover Knee Replacements And More
Because Medicare Advantage plans must offer the same benefits as Medicare Part A and Medicare Part B, your Medicare Advantage plan should cover your knee replacement surgery if a doctor says it is medically necessary.
If youre eligible for Medicare enrollment or are interested in changing to a Medicare Advantage plan, call a licensed insurance agent today to see what Medicare Advantage plans are available in your area.
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1 Ubel, Peter. Medicare Is Reducing The Cost Of Knee Replacements . . Forbes. Retrieved from www.forbes.com/sites/peterubel/2017/02/10/medicare-is-reducing-the-cost-of-knee-replacements-heres-how-that-could-backfire/#279a55416392.
2 BlueCross BlueShield. . Planned knee and hip replacement surgeries are on the rise in the U.S. Retrieved from www.bcbs.com/the-health-of-america/reports/planned-knee-and-hip-replacement-surgeries-are-the-rise-the-us.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Where youve seen coverage of Christians research and reports:
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Does Medicare Cover Physical Therapy In A Skilled Nursing Facility
Medicare covers physical therapy in a skilled nursing facility when your doctor prescribes it. To enter a skilled facility, you must have had a hospital stay of at least three days and be admitted within 30 days of discharge from the hospital.
Medicare pays for the first 20 days of a skilled nursing stay in full, including any physical therapy you receive there. For days 21 through 100, you pay a daily coinsurance of $194.50. Starting with day 101, you’re responsible for the full cost of your services.
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