Does Medicare Cover Physical Therapy? 

Physical therapy is one of the leading solutions for rehabilitation after an injury or surgery. Many medical professionals also recommend physical therapy before turning to invasive procedures or potentially harmful prescription medications. Seniors in the United States are some of the most frequent patients of physical therapists, and it’s likely that this will continue as Baby Boomers are living longer lives.  

Original Medicare benefits cover physical therapy in both inpatient and outpatient settings. The  number of physical therapy services that can be covered by Medicare insurance will be based on physician orders and your needs. 

Medicare Part A and physical therapy coverage

Medicare Part A pays for services provided to Medicare recipients while they are admitted to Medicare-participating hospitals or skilled nursing facilities. If physical therapy is ordered while you are admitted, these services are covered by Medicare Part A as long as the services are administered by staff of the inpatient facility. If a separate provider is brought in to provide physical therapy, that provider sends a separate bill and may be covered by Part B.

Under Medicare Part A, you can receive full-coverage care in a hospital for up to 60 days each benefit period. An additional 30 days of inpatient coverage is available by paying a per-day coinsurance. If admitted to a skilled nursing facility, you receive 20 days of full-coverage care with 80 additional days available with a coinsurance.

Medicare Part B and physical therapy coverage

Medicare Part B supplies outpatient coverage to Medicare recipients. Part B is the part of Medicare most commonly used to pay for physical therapy since most physical therapy takes place in an outpatient setting. In order for services to be covered, however, they must be administered by a Medicare-participating physical therapist.

Additionally, it’s important to draw a distinction between what is considered physical therapy and what is considered alternative therapy. Yoga, for instance, can potentially be classified as a therapeutic physical activity, but it does not fall into the category of recognized medical physical therapy. Likewise, exercise classes may be physical in nature and promote health, but they are not considered physical therapy either.

Prescription medication coverage in conjunction with physical therapy

Although physical therapy is often ordered as an alternative to treatment using prescription medications, some Medicare recipients may require combination therapy. Prescription medications are covered through Medicare Part D. This coverage is optional, but if you don’t enroll when you’re eligible during your Initial Enrollment Period, you may have to pay late enrollment fees. 

Medicare Part D plans each come with a formulary that lists the plan’s covered medications. If you are prescribed medications to take in conjunction with physical therapy, you can compare your prescriptions against your formulary to see what is covered. If a prescription is not covered, you may be able to file an exception waiver with the Centers for Medicare & Medicaid Services (CMS).

Medicare Advantage and physical therapy

Medicare Advantage plans combine the benefits of Original Medicare Parts A and B, with additional benefits offered by providers. Medicare recipients may have access to exercise classes through programs like SilverSneakers under a Medicare Advantage plan, but this can vary from provider to provider. To learn about the options available in your area, you’re encouraged to work with an independent Medicare Advantage insurance broker who can help you shop plans based on your unique needs.

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