Is Outpatient Physical Therapy Covered by Medicare?
Physical therapy is costly. However, it is often necessary expense people must pay to take care of their body. In the U.S, the average cost of receiving physical therapy can range anywhere from $75 to $150 per session without health insurance. Luckily, Medicare can help take care of the costs if you’re a subscriber. If you want to learn more about what else is covered by this federal health insurance program, make sure to search online. It’s important to understand the various costs and plans involved with Medicare to ensure you are getting the right coverage for your needs whether you’re dealing with physical therapy costs for the first time or repeatedly. If you require coverage for outpatient physical therapy, search online to learn more about what costs Medicare can cover.
Here’s what you need to know about outpatient physical therapy coverage from Medicare.
What Medicare Covers
Medicare offers different types of plans offering various forms of coverage. For people who need outpatient physical therapy coverage, Part B is the plan that offers just the right coverage.
Medicare Part B covers two types of services: medically necessary services and preventive services.
Medically necessary services are considered services or supplies needed to diagnose and treat medical conditions. Preventative services are considered health care to prevent illness or detect it at an early stage when treatment will likely work best. Here are some examples of what Part B covers:
- Ambulance services
- Durable medical equipment
- Mental health
- Clinical research
- Limited outpatient prescription drugs
The Part B plan includes coverage for outpatient therapy that is deemed medically necessary by your doctor. This means physical therapy, speech-language pathology and occupational therapy qualify, as long as your doctor prescribes them. The good news is Medicare no longer limits how much it pays for these types of services on one calendar year.
According to Medicare Interactive, the following will be covered by Original Medicare in 2021:
- $2,110 for physical therapy and speech-language pathology before requiring your provider to indicate that your care is medically necessary
- $2,100 for occupational therapy before requiring your provider to indicate that your care is medically necessary
Medicare will cover up to 80 percent of the approved amount. It is possible that Medicare can deny coverage if it’s not deemed medically necessary. In this case, you can appeal to try and gain coverage.
How Much Coverage Costs
Some people may already be covered for Part B if they are on a Medicare Advantage Plan or are currently subscribed to Original Medicare.
The cost of Part B coverage will depend on a number of factors, such as your income. Most people will pay a standard amount of $148.50 in 2021 for a premium amount. This number is directed at customers who filed an individual tax return of $88,000 or less and joint tax return of $176,000 or less two years ago. The cost of coverage will increase depending on your income.
There is also the annual deductible and coinsurance to keep in mind. Customers will pay $203 for their Part B deductible in 2021. Once the deductible is met for the year, you will typically pay 20 percent of the Medicare-approved amount for most doctor services, outpatient therapy and Durable Medical Equipment.
Search Online to Learn More About Medicare
Those needing physical therapy should look into whether Medicare will cover the cost. If it’s deemed medically necessary, you can avoid paying high fees completely out of pocket.
Outpatient therapy includes therapy received at a therapists’ or doctor’s office, Comprehensive Outpatient rehabilitation Facilities (CORFs), skilled nursing facilities and even at-home therapists. If you’re looking for more coverage than what Plan B has to offer, there are other Medicare health plans to consider.
Here is a rundown of what each plan covers:
- Part A: hospital insurance that covers inpatient hospital stays, care in a nursing facility, hospice care, etc.
- Part C: a Medicare Advantage plan that provides you with both Part A and Part B coverage
- Part D: prescription drug coverage
- Medigap: Supplement insurance sold by private companies that can help pay for remaining costs that your Medicare plan does not cover (ex. Copayments, coinsurance or deductibles)
Search online to learn more about Medicare health plans. You can research each plan and decide which one makes most sense for you. And if you ever want to make adjustments to your plan in the future, you can do so during Medicare’s annual open enrollment period.