Physical therapy is a form of movement therapy that aids in rehabilitating injuries and illnesses that limit the ability to move and perform daily tasks. It usually consists of manual therapy, specific exercises, or manipulation techniques designed to strengthen the body. As we age, our bodies are more prone to stiffness or injury. Thankfully, Medicare–a governmental healthcare program offered to seniors aged 65 and older–covers the cost of physical therapy.
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Does Medicare Cover Physical Therapy?
Medicare pays for physical therapy services when prescribed by a doctor or other healthcare provider. Doctors often recommend physical therapy for patients recovering from a stroke, a fall, or surgery, as well as after a Parkinson’s diagnosis or a diagnosis of another chronic illness.
Original Medicare (Parts A and B)
Both parts of Original Medicare (Parts A and B) cover physical therapy services. Part A covers physical therapy in an inpatient setting. Patients in long-term care or treatment facilities can expect Part A to cover most costs depending on the location and how long the patient is in care. Part A may also pay for in-home physical therapy sessions after long-term hospitalization.
Part B covers physical therapy sessions received at outpatient rehab facilities and hospital outpatient departments, as well as in skilled nursing facilities if the patient is being treated as an outpatient. Part B also covers sessions at a doctor’s or therapist’s office, or at home if Part A doesn’t cover it.
Medicare Advantage (Part C)
Medicare Advantage, also known as Medicare Part C, covers physical therapy sessions in the same way that Original Medicare does. This is because Medicare Advantage is similar to Original Medicare, except beneficiaries obtain coverage through private insurance instead of the government program.
Patients may need referrals from primary care physicians depending on the requirements of the specific Medicare Advantage plan. Recipients may also be required to stay within their network for Medicare Advantage coverage.
Patients that receive therapy under this plan may be required to pay coinsurance, a deductible, or a copay for inpatient or outpatient services. Patients under Original Medicare may be able to avoid these payments depending on their plan additions. The cost of Medicare Advantage varies from plan to plan.
Medigap
Medigap may cover your Original Medicare copay and coinsurance costs when it comes to physical therapy, as well as the deductible amount, depending on the type of Medigap plan you have.
This is because Medigap, also known as a Medicare Supplement, is a program that covers the beneficiary’s financial gaps in Medicare. Similar to Medicare Advantage, Medigap is available through private insurance programs. Patients can only choose a Medicare supplement plan if they have Original Medicare.
With Medigap, patients can work with both in-network and out-of-network doctors, allowing patients to see specialists without a referral.
Where Will Medicare Cover Physical Therapy?
Medicare will generally cover physical therapy from any Medicare-participating doctor or specialist. Facilities include inpatient and outpatient facilities, skilled nursing facilities, telehealth appointments, and in-home care. Treatment can also include chiropractic services, acupuncture services, or any other type of alternative medical treatment that can improve pain.
Inpatient Facility
An inpatient facility is a medical facility where a doctor admits patients for an overnight stay and observation. Some inpatient facilities are long-term, like nursing homes, skilled nursing facilities, or assisted living centers. Others are short-term, like a hospital stay after an injury or an illness.
For example, a doctor admits a patient who has suffered a stroke to the hospital for a few days of observation. If the stroke caused delays in motor function, a doctor may order physical therapy as a rehabilitation treatment.
Original Medicare provides patients with 60 days of inpatient care within a benefit period. If the doctor recommends physical therapy, Medicare Part A will cover the inpatient stay plus any physical therapy sessions if the patient has inpatient days left in their benefit period. The patient may have to transfer to a skilled nursing facility within 30 days after staying at least three days in an inpatient facility.
Treatment for the patient has to address the same condition that landed them in the hospital or skilled nursing facility. Treatment can also extend to a condition that developed or worsened while the patient was in the care facility.
Outpatient Facility
An outpatient facility is a facility that a patient travels to for care. Outpatient facilities include therapy offices, outpatient wings of hospitals, and doctor’s offices.
A patient living at home with a progressive, chronic condition like Parkinson’s disease could need physical therapy to slow the progression of the disease and alleviate any stiffness and pain that the disease causes. The patient would travel to their physical therapist’s office for treatment and learn exercises they can do from home. The physical therapist may also come to the patient’s home to treat them there.
In 2023, Medicare Part B will cover 80% of outpatient services after the patient has met their deductible of $226. The patient is then responsible for the remaining 20% copay.
Skilled Nursing Facility (SNF)
A skilled nursing facility is a medical treatment facility or an inpatient rehab center staffed with medical professionals. The nurses follow treatment plans under a medical doctor’s direction and supervision. The medical staff may include occupational and physical therapists, audiologists, and speech pathologists.
Staff in skilled nursing facilities perform the medically necessary treatment to rehab patients from serious illnesses or injuries to where they were before the incident occurred. Skilled nursing facilities keep patients for shorter periods than in a nursing home.
As long as the patient still has inpatient days available during their benefit period and is there longer than three days, Medicare Part A covers their stay and physical therapy sessions.
Telehealth
Telehealth is a service where patients can meet with healthcare providers via audio and video equipment instead of in person. Covered telehealth services can include:
- Therapy or online counseling.
- Treatment of skin conditions.
- Post-surgical follow-up.
- X-ray or lab result consultations.
Medicare Part B covers Telehealth services as it relates to physical therapy.
At Home
Physical therapists can make house calls to their patients as long as a doctor deems them medically necessary. Whether the patient needs the session for an inpatient or outpatient issue determines whether Part A or B will cover the session.
How Much Does Physical Therapy Cost?
Because Medicare covers physical therapy, you may only have to consider the costs of Medicare coverage itself. Medicare Part A is free for those who have worked and paid into the Medicare program for at least ten years. As of 2023, Medicare Part A carries a $1,600 deductible for each benefit period, which is a period when a patient is receiving Medicare services.
As of 2023, Medicare Part B carries a $164.90 monthly premium for the services. On top of the annual deductible for Medicare Part B mentioned above, patients are responsible for 20% coinsurance, a portion of the Medicare-covered services they receive for the remainder of the year.
The costs of Medicare Advantage and Medigap depend on the policy and where the patient lives.
Alternative Pain Management Options Covered by Medicare
A doctor may order a different treatment for pain management, depending on the circumstance. Medicare Part B covers:
- Acupuncture: A traditional Chinese treatment involving strategically placed pressure points may help lower back pain.
- Occupational Therapy: This therapy allows patients who experience pain during simple tasks to regain strength and range of motion to perform those tasks comfortably.
- Depression Screenings: Chronic pain can cause depression and depressive episodes, making the pain worse. Doctors can conduct the screenings and then suggest treatment options to minimize discomfort.
- Chiropractic Services: This type of physical therapy is designed to realign the spine to alleviate back pain, as well as pain in the rest of the body.
- Alcohol Use Counseling and Screening: An uptick in pain can cause an uptick in substance use, leading to different health problems.