If you’re in need of physical therapy, you may be wondering whether Medicare will help cover the cost. The good news is that it does—but there are some important details to keep in mind. If you’re recovering from surgery, managing a chronic condition, or simply working to improve mobility, getting a better understanding of what Medicare covers should help you plan for any potential expenses.
How Medicare Pays for Physical Therapy
Medicare has different parts, and how your therapy is covered depends on where you receive treatment and the type of care you need. Here’s a breakdown of how each part applies:
Medicare Part A (Hospital Insurance)
Part A covers physical therapy when it’s provided in a hospital or skilled nursing facility (SNF).
- Hospital Stays: If you’re hospitalized and require therapy as part of your recovery, Part A helps pay for it. This is often the case after major surgeries, strokes, or other serious medical conditions.
- Skilled Nursing Facility (SNF): If you move to a skilled nursing facility for rehabilitation after a hospital stay of at least three days, Medicare may cover physical therapy as part of your treatment plan.
Medicare Part B (Medical Insurance)
Most outpatient physical therapy falls under Part B, meaning it covers therapy sessions at a clinic, doctor’s office, or even in your home if you qualify.
- Medical Necessity: A doctor must determine that physical therapy is necessary for your condition.
- Approved Providers: The therapy must be given by a provider who participates in Medicare.
- Your Costs: After meeting your Part B deductible, Medicare typically covers 80% of the cost. You’ll be responsible for the remaining 20% unless you have supplemental coverage, like a Medigap policy or a Medicare Advantage plan.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage plans (Part C) are managed by private insurance companies and must at least match the coverage of Original Medicare (Parts A and B). However, each plan has its own provider network, pricing, and coverage rules. Some plans may offer extra benefits, such as lower copays or coverage for additional therapy sessions. If you have a Medicare Advantage plan, check with your provider to confirm what’s included.
Medicare Part D (Prescription Drug Coverage)
While Part D doesn’t pay for physical therapy directly, it helps cover the cost of prescription medications your doctor may recommend as part of your therapy—such as pain relievers or muscle relaxants.
How Many Physical Therapy Sessions Does Medicare Cover?
In the past, Medicare had a cap on how much it would pay for outpatient therapy services, but that limit no longer applies. Therapy is covered as long as it is medically necessary. However, if your therapy costs exceed a certain amount ($2,330 in 2024), your therapist may need to provide additional documentation to confirm that continued treatment is still required.
Does Medicare Cover In-Home Physical Therapy?
Yes, but only under specific conditions. Medicare will cover home health services, including physical therapy, if:
- A doctor certifies that in-home therapy is necessary.
- You are considered “homebound,” meaning it is difficult for you to leave your home without assistance.
- The therapy is provided by a Medicare-certified home health agency.
This coverage falls under Medicare Part B and is usually fully covered, meaning you may not have to pay anything out-of-pocket.
How to Get Medicare-Covered Physical Therapy
If you need physical therapy and want Medicare to cover it, follow these steps:
- Talk to Your Doctor: A physician must document that therapy is needed for your condition.
- Find a Medicare-Approved Provider: Make sure your therapist or facility accepts Medicare. You can check the Medicare website or ask the provider directly.
- Understand Your Costs: With Original Medicare, you’ll typically pay 20% of therapy costs after meeting your Part B deductible. If you have a Medicare Advantage plan, contact your insurer for details.
Wyomissing Physical Therapy | Direct Access PT Reading PA
Dr. Joe Miller of Wyomissing Physical Therapy is a seasoned sports physical therapist with decades of experience. We are committed to providing top-tier care and tailored treatment for residents of Berks County and neighboring communities. To make our services more accessible, we accept multiple insurance plans. As certified Direct Access providers by the Pennsylvania Physical Therapy Association, we enable patients to start therapy without a physician’s referral, eliminating unnecessary delays. Begin your journey toward better health and peak performance—book your appointment today!
