Does Medicare Cover Physical Therapy At Home
Physical therapy is a common way to treat many types of chronic pain such as lower back pain. It is also used to relieve limited mobility in the joints or to help you recover from an injury or surgery.
Often people will go to a physical therapists office for treatment. But, in some cases, theres an option to have the therapist come to you.
So a common question many people have is, does Medicare cover physical therapy at home? In this article, we answer that question in clear, plain English. You will also find the average costs of home service physical therapy, as well as other helpful info.
Does Medicare Cover Home Health Care
In order to receive home health care, Medicare have set out a list of requirements that people must meet in order to receive financial help. These include:
- Your doctor prescribing home health care for you.
- You must require part-time skilled nursing care or physical, speech, or occupational therapy.
- The home health care must be provided by a Medicare-approved agency.
- You must be confined to your home by an injury, illness, or other medical condition.
- Your doctor must help set up a care plan in cooperation with the home health care agency.
It used to be a requirement of Medicare that the home health care must be expected to improve your condition, but a change to this means that you can now qualify if it means that you can maintain your condition or slow down the deterioration of your condition.
Should you require full-time nursing care, though, Medicare will not give the green light for home health care, although they may help cover the cost of a skilled nursing facility.
What Doesnt Medicare Cover For Parkinsons Disease Treatment
Unfortunately, Medicare doesnt cover everything you may think is medically necessary. These services include nonmedical custodial care for daily living activities, such as dressing, bathing, and cooking. Medicare also doesnt cover long-term care or around-the-clock care.
Don’t Miss: Is Pennsaid Covered By Medicare
Medicare Part B Part A And Medicare Advantage Plans Cover Physical Therapy
Outpatient physical therapy is typically covered by Medicare Part B. Physical therapy patients with Part B will be responsible for meeting their annual Part B deductible along with a 20% coinsurance payment for any remaining costs.
Outpatient physical therapy may be performed in:
- Medical offices
- Skilled nursing facilities
- At home
Inpatient physical therapy may be covered under Medicare Part A. Inpatient physical therapy is performed at hospitals, mental health facilities, skilled nursing facilities and rehabilitation centers. Your costs for inpatient physical therapy will typically be built into the inpatient deductible that you are responsible for under Medicare Part A.
Both inpatient and outpatient physical therapy are also covered by Medicare Part C plans, which are also known as Medicare Advantage. These plans include all of the same coverage as Part A and Part B in addition to typically having some extra benefits. The deductibles and coinsurance for these plans will vary.
What Does Homebound Mean
If a practice is considering seeing patients in their home instead of the clinic then you must be sure the patient meets the definition of homebound.
According to Medicare patients must meet the following criteria to be considered homebound:
Criterion One: The patient must either: – due to their illness or injury, need to use crutches, canes, wheelchairs, and walkers or special transportation or the assistance of another person in order to leave their place of residence.OR
Also Check: When Do You Sign Up For Medicare
Medicare Coverage For Parkinsons Disease
- Medicare covers medications, therapies, and other services involved treating Parkinsons disease and its symptoms.
- Physical therapy, occupational therapy, and speech therapy are all included in this coverage.
- You can expect some out-of-pockets costs, even with your Medicare coverage.
Medicare covers medically necessary treatments for Parkinsons disease, including medications, different types of therapy, and hospital stays. Based on the type of coverage you have, you may have some out-of-pocket expenses, such as copays, coinsurance, and premiums.
Medicare may not cover all of the services youll need, such as assistance for normal daily living.
If you or a loved one has Parkinsons disease, its important for you to understand which parts of Medicare cover which treatments to avoid large, unexpected expenses.
Physical Therapy That Targets Your Needs
Movement and muscle strength bring freedom. For some, that means returning to work or resuming an active lifestyle after surgery. For others, it means moving safely around their homes.
No matter your goal, our physical therapists work to help you achieve it. Our physical therapy includes specialized, targeted programs and practices:
- Total joint therapy: If you receive a new hip, knee or shoulder, our therapists use the newest technology and mobilization techniques. They get you strong enough to attend outpatient therapy.
- Chronic disease program: Our specialty-trained physical therapists personalize therapy and prescribe exercises specific to people living with heart failure and chronic obstructive pulmonary disease .
- Vestibular training: If you have inner ear problems or get a spinning feeling called vertigo, our specialized vestibular therapists can help. They know how to improve your balance and movement.
- Program for Parkinsons disease: If you have Parkinsons disease, we offer therapists certified by the LSVT Big® program, which addresses the conditions physical challenges. Treatment helps you with walking, self-care and other tasks.
- Lymphedema relief: Our lymphedema-certified therapists use massage, manual drainage and exercise to treat swelling and poor circulation.
Read Also: How Old To Be Eligible For Medicare
Why Is Physical Therapy Valuable
According to the American Physical Therapy Association , physical therapy can help you regain or maintain your ability to move and function after injury or illness. Physical therapy can also help you manage your pain or overcome a disability. Physical therapists are specially trained and licensed to prescribe exercises, provide education, and give hands-on care to you in various settings.
How Do You Get In
If you suffer an injury or illness that limits your ability to move around normally, you may benefit from PT. And if you cannot leave the house, home-care physical therapy may be the best option.
Most patients who receive home-care physical therapy are referred to the service by their healthcare provider. Your healthcare provider can make the referral to a local visiting nurse service that offers physical therapy, and he or she can attest that home services are medically necessary. This medical necessity report will likely also state that home-care physical therapy is needed because you are unable to leave the house due to your condition or circumstances.
If you feel you may benefit from physical therapy at home, you can also call your local physical therapy clinic or visiting nurse association. Those organizations can help you navigate the pathway to receiving home-care PT.
Also Check: How To Purchase Medicare Insurance
Skilled Maintenance Therapy Under Medicare
Medicare does indeed cover services to maintain or manage a beneficiary’s current condition when no functional improvement is possible.
There has been a longstanding myth that Medicare does not cover services to maintain or manage a beneficiary’s current condition when no functional improvement is possible. The 2013 Jimmo vs. Sebelius settlement sought to dispel this fallacy and provide clarifications to safeguard against unfair denials by Medicare contractors for skilled therapy services that aid in maintaining a patient’s current condition or to prevent or slow decline.
Several nonfederal payers also have clarified their policies regarding the improvement standard and skilled maintenance coverage.
Questions To Ask Your Physical Therapist
How many physical therapy sessions will my course of treatment require?
What is the charge for each physical therapy appointment?
In case total charges exceed $2,010, will you have submitted documentation to Medicare to ensure that my treatment can continue uninterrupted?
Physical therapists must bill for their services in quarter-hour increments, and the so-called 8-minute rule dictates how to round up or down for sessions of a duration that isnt a multiple of 15 minutes .
If a session is 8 minutes or more beyond a multiple of 15, then it is rounded up. For example, a 38-minute session will be rounded up to 45 minutes for billing. If a session is 7 minutes or less beyond a multiple of 15, then it is rounded down. So if a session is 37 minutes, it will be rounded down for billing purposes.
If you have questions about your bill, you can ask your physical therapist or their office staff to explain it to you and you deserve that explanation.
About the author:John Rossheim is an editor and writer specializing in health care and workforce trends. His work has appeared in The Washington Post and on MSN, Monster and dozens of other websites.Read more
When Should I Stop Doing In
As a general rule, you should continue your physical therapy until you reach your therapy goals or until you and your therapist decide that your goals need to be re-evaluated due to the severity of your condition. Physical therapy is by no means an indefinite commitment, but it is one you want to see through to the end whether that end is six weeks away or twelve weeks away if you want to get the best results.
What If Medicare Won’t Cover All My Physical Therapy
Medicare no longer caps how much medically necessary physical therapy it will cover throughout the year. But in some cases, doctors might recommend physical therapy beyond what Medicare considers medically necessary. In this case, you may be stuck paying for additional treatment sessions out of your own pocket.
To help pay these costs, you could turn to Medicaid, which helps some low-income people, pregnant women, and families cover their health care costs.
Otherwise, consider switching from Original Medicare to Medicare Advantage. Many Medicare Advantage plans cover more services than Original Medicare, so you could find a plan that pays for more physical therapy.
Learn more about the differences between Original Medicare and Medicare Advantage.
Also Check: Does Kaiser Permanente Take Medicare
What Medicare Pays For
You will have 100 percent of your home health care costs paid for as part of Medicare Part A, while it is worth noting that there is no limit on the number of home visits they will pay for. In addition, should your physician prescribe home care, Medicare will pay for the initial evaluation to see if you are a good candidate.
Something to bear in mind is that Medicare Part A will only pay for home health care if it comes after a prior three-day stay in hospital, otherwise it will be Medicare Part B that pays out for home health services.
Medicare will fund 100 percent of home health care services if it is related to:
- Part-time skilled nursing care-usually two to three visits per week in a plan certified by a physician
- Physical therapy
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.
New To Medicare?
Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.
You May Like: What Age Qualifies You For Medicare
When Does Medicare Pay For Physical Therapy
Medicare Part B does cover physical therapy in a variety of outpatient settings, including:
The offices of private practitioners
Outpatient hospital departments, including critical access hospitals
At home, from providers that include privately practicing therapists and home health agencies
Where To Get Help
The Medicare handbook is sent to everyone, regardless of how youre getting services, Fassieux says.
Look for a copy in the mail every fall that youre signed up for Medicare. Inside, youll find a section about home health care services.
Free one-on-one help is also available in every state and U.S. territory through your State Health Insurance Assistance Program . Youll find contact info for your local office in the Medicare handbook or call 1-800-MEDICARE /TTY: 1-877-486-2048.
The bottom line? Medicare doesnt cover everything, Fassieux says. Youve got to have a good plan for long-term care. Build your finances around the knowledge that ultimately there will be out-of-pocket costs.
You May Like: How To Apply For Medicare Card Replacement
Does Medicare Cover In
Medicare Part B medical insurance will cover at home physical therapy from certain providers including private practice therapists and certain home health care providers.
If you qualify, your costs are $0 for home health physical therapy services. But you will pay 20 percent of the Medicare-approved amount for durable medical equipment wheelchairs, walkers and other such medical devices and equipment.
You have to have Medicare Part A and/or Part B and meet all items on a list of requirements from Medicare to be eligible for at home therapy.
Medicare Eligibility for Home Physical Therapy Coverage
- You must be under the care of a doctor.
- You must have a plan of care your doctor created and regularly reviews.
- A doctor must certify that you need one or more of these:
- Intermittent skilled nursing care other than drawing blood.
- Physical therapy scheduled over a reasonable time frame that is specific, safe and effective treatment for your condition by a Medicare-approved provider.
- That you are homebound.
You are not eligible for home PT services if you need more than part-time skilled nursing care. You may still get home services if you attend adult day care. You may still be considered homebound even if you leave home for medical treatment or short, rare nonmedical reasons such as attending religious services.
What Is Physical Therapy
Physical therapy is a service that optimizes quality of life by utilizing prescribed physical exercise, hands-on care and patient education. Physical therapists may work in hospitals, hospice centers, rehabilitation facilities, doctors offices, fitness centers and private physical therapy practices.
Physical therapy is used to treat patients following injuries, surgeries, neurological episodes such as strokes and patients who are experiencing chronic pain, discomfort and arthritis. Not all physical therapists are the same. Many tend to specialize in one or more specific areas and types of physical therapy.
Physical therapy treatment can involve stretching, exercising, the use of equipment like walkers and more.
Recommended Reading: Can You Change Medicare Plans After Open Enrollment
Who Pays For Medicare Part B Coverage
The people receiving care will first have to elect Medicare Part B coverage, which requires them to pay a premium. For 2021, this amount is $148.50 for those making $88,000 or less. There is also a deductible, which is $203 for 2021, that must be paid, either by the patient/resident or a co-insurer. The deductible can be paid to any provider of Medicare Part B services. In other words, prior to entering a facility, a senior may have already met his or her deductible elsewhere and will, thus, not have to pay it at the facility. Once that deductible is met, one will be covered by Medicare.
Medicare covers 80% of the fee schedules of Part B that will be detailed below. Certain states will pay the remaining twenty percent, or, the coinsurance amount. In most states, it is possible to get Medicaid to pay the Medicare coinsurance, but this process is not automatic in all states. Co-insurance is provided in accordance with state regulations. States that do not pay the coinsurance will most likely ask a long term care facility to write off the remaining amount.
Parkinsons Disease And Medicare Coverage
Medicare is made up of multiple parts. Each part covers different services and treatments that youll need to manage Parkinsons.
Original Medicare is composed of Part A and Part B. Part A covers a portion of your inpatient hospitalization costs. Part B provides coverage of outpatient medical needs including those for diagnosis, treatment, and prevention.
Read Also: Does Medicare Cover Total Knee Replacement
What Does Medicare Pay For After A Stroke
Part A will cover any inpatient rehab you may need after your stroke. Your doctor must deem that rehabilitation is medically necessary for treating you following the stroke. There are deductibles, coinsurances, and limits to the number of days you can spend in the hospital when Medicare is your only insurance.
Medicare Coverage For Inpatient Physical Therapy
Medicare Part A covers medically necessary inpatient physical therapy at inpatient rehabilitation facilities sometimes called an inpatient rehab facility , acute care rehabilitation center or rehabilitation hospital.
You will still be responsible for a deductible, coinsurance and copayments.
Your Costs When Medicare Covers Physical Therapy
- Days 1 to 60
Read Also: Should I Get Medicare Part C
Common Types Of Physical Therapy For Seniors
Because there are so many different reasons for going through physical therapy, there are several different types of therapy that can match each unique need.
Depending on your situation, your doctor may recommend one of the following types of physical therapy.
- Orthopedic physical therapy targets injuries to bones, muscles, ligaments and tendons.
- Geriatric physical therapy is designed to address age-related conditions such as arthritis, Alzheimers or hip replacement recovery.
- Neurological physical therapy can assist with neurological disorders such as brain injuries, strokes, Parkinsons disease, multiple sclerosis, cerebral palsy and Alzheimers.
- Cardiovascular or pulmonary rehabilitation aids seniors with heart and lung disorders.
- Wound care therapy can help a wound properly heal by promoting adequate oxygen and blood flow.
- Vestibular therapy is used to treat balance problems that can arise from inner ear infections or other problems affecting ones equilibrium.
- works to drain built-up fluid in patients with lymphedema and other conditions.
- Pelvic floor rehabilitation aims to treat complications in the digestive system along with pelvic pain resulting from injuries, surgery or other conditions.
As there are different types of physical therapy, there are also a number of different methods that may be used to deliver therapeutic treatment.
Some of the physical therapy methods used to treat seniors include: