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Does Original Medicare cover physical therapy?
Physical therapy is an important service to support your wellbeing and recovery, especially after an injury or surgery. If you need physical therapy, you may be wondering if your Original Medicare plan will cover it.The good news is Medicare Parts A and B, also known as Original Medicare, will pay for physical therapy. However, Parts A and B will each pay for different services and under specific conditions. Let’s walk through the rules for physical therapy coverage with Original Medicare so you can better understand your benefits and get the care you need.
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What are the rules for physical therapy coverage with Original Medicare?
Physical therapy services are covered both by Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). However, the physical therapy must be ordered by your doctor as a medically necessary treatment—for example, if you’ve just had knee surgery and need physical therapy to restore function during your recovery. Medicare Part A will cover inpatient physical therapy during a hospital stay, as well as physical therapy in a skilled nursing facility (SNF) after you’ve been discharged from a hospital stay of at least three days. Medicare Part B will pay for physical therapy either in an outpatient or a home setting, but for at-home therapy to be covered, you must meet certain conditions: you must be under a doctor’s care, the therapy must improve or at least maintain your current condition, and your doctor will need to certify that you’re homebound. Medicare Advantage plans will also provide these coverages for physical therapy, because these plans must legally offer the same benefits as Original Medicare.
What types of physical therapy are covered by Original Medicare?
As long as you meet the requirements set by your plan, Original Medicare will cover physical therapy in a variety of settings, including inpatient, outpatient and home health. It may even cover telehealth physical therapy if this option is available to you. It will also cover specialized physical therapy services, like aquatic physical therapy, as long as the treatment is ordered by your doctor.
FAQs about Original Medicare and Physical Therapy
Do I need a referral for physical therapy under Original Medicare?
Yes, in order to receive Original Medicare coverage for physical therapy, you must be referred by a physician.
What out-of-pocket costs do I pay for physical therapy services under Medicare?
You must meet your Original Medicare deductibles before coverage for physical therapy will kick in. For Part A, your 2023 deductible is $1,600 per benefit period. For Part B, your 2023 annual deductible is $226.
Does Original Medicare cover transportation to therapy appointments?
Original Medicare does not cover non-emergency transportation.
Does Original Medicare cover occupational therapy?
Occupational therapy is a practice similar to physical therapy that focuses on improving function and independence toward performing day-to-day tasks, like bathing, eating and dressing. Original Medicare does cover occupational therapy under the same parameters as physical therapy: it must be ordered by a doctor and must be deemed medically necessary.
Have questions about your Medicare Plan coverage? Let SelectQuote help.
At SelectQuote, we want to help ensure you’re getting the benefits available to you through your Medicare Advantage plan coverage, and that includes physical therapy. Our experienced licensed insurance agents can search and compare Medicare Advantage plans on your behalf, helping you sift through plan and coverage details to find the right fit for your needs.
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