Medicare provides coverage for physical therapy, but understanding the specifics of what’s included is essential to maximizing your Medicare benefits. Medicare Parts A and B cover physical therapy that’s medically necessary for treating an illness or injury, managing chronic conditions like Parkinson’s, or recovering from events like falls, strokes, or surgeries. At Skyline Benefit, our agents help clients navigate these Medicare benefits to ensure they understand their coverage options for physical therapy and make the most of their healthcare plan.
What Physical Therapy Does Medicare Part A Cover?
Medicare Part A covers inpatient stays where physical therapy is part of a broader hospital or skilled nursing facility admission. Coverage extends to therapy at inpatient rehabilitation facilities and physical therapy for home-based patients when eligible.
What Physical Therapy Does Medicare Part B Cover?
Once you meet the annual Part B deductible, Medicare covers 80% of the Medicare-approved amount for outpatient therapy services. Your doctor or therapist must develop and periodically review your care plan. Medicare Part B covers outpatient physical therapy, occupational therapy and speech-language pathology.
Does Medicare Advantage Cover Physical Therapy?
Medicare Advantage (Part C) plans also cover physical therapy but may come with different rules, including network restrictions and copay requirements. Unlike Original Medicare, which covers 80% of the cost after the deductible, Medicare Advantage plans often use copayment structures, such as a flat rate between $10 and $40 for each visit.
If you’re considering Medicare Advantage for physical therapy coverage, Skyline Benefit can help you compare plans to find the best fit.
Are There Coverage Caps or Limits for Physical Therapy?
Although Medicare eliminated its annual cap for therapy services in 2018, therapy services that reach a certain spending threshold still require additional provider confirmation. In 2024, the threshold is $2,330 for combined physical therapy and speech-language pathology and $2,330 for occupational therapy. This spending threshold ensures that therapy remains medically necessary as treatment continues.
Choosing Between Original Medicare and Medicare Advantage for Physical Therapy
Medicare Advantage plans and Original Medicare provide the same baseline physical therapy benefits, but the difference lies in costs, flexibility, and provider choice. Original Medicare offers more freedom in selecting providers, while Medicare Advantage often has structured copayments and limited networks.
- Original Medicare: Suitable if you prefer broader provider choices and are comfortable with Part B’s 20% coinsurance.
- Medicare Advantage: May be a better choice if you’re looking for lower, fixed copayments and are willing to work within a plan network.
Looking for Guidance on Medicare and Physical Therapy Coverage?
Skyline Benefit is an independent Medicare insurance broker dedicated to helping you find affordable and comprehensive Medicare options. With so many plans and coverage options, understanding what’s best for your health needs can be overwhelming. Our team is here to simplify the process and support you in making the best decision for your physical therapy coverage.
Schedule a consultation today. Call us at: (714) 888-5112