There are many reasons why you may need physical therapy at some point in your life. Whether that’s recovering from a health emergency like a stroke or heart attack or combating age-related physical decline by improving flexibility and balance, physical therapy can have amazing effects on your personal well-being and quality of life.
How physical therapy is covered and which part of Medicare covers it depends on the circumstances. The key word for whether it’ll be covered is “medically necessary.”
Inpatient Rehab Treatment
- If you’re at an inpatient facility, your physical therapy will likely be covered by Original Medicare as part of your overall treatment.
- To receive coverage for this, your doctor would need to certify that this treatment is medically necessary and that you have a medical condition that requires sustained supervision, intensive rehabilitation, and coordinated care.
- Original Medicare should cover your rehabilitation treatment (like physical therapy), meals, skilled nursing care, a semi-private room, medications, and other hospital services and supplies.
- It will not cover the costs of a phone or television, private nursing care, personal items, or a private room, unless it’s medically necessary.
- Medicare Part A is the part you’ll be dealing with. This will be treated like any inpatient facility, and even tack on to a hospital stay that you had immediately prior to your inpatient rehabilitation facility stay.
- This means that you may not need to pay a deductible at the start of your stay at the inpatient facility, since it would be considered the same benefit period as your hospital stay, where the deductible would likely already have been met.
- If you just have Original Medicare, are admitted to a hospital as "inpatient", then get transferred to a skilled nursing facility for care or rehab., you must have a 3 day inpatient hospital stay (admitted) in order for Original Medicare to cover skilled nursing facility care. (Note: most or all Medicare Advantage plans do not require the prior 3 day inpatient hospital stay when transferred to a skilled nursing facility).
Once you’ve hit your deductible, you’ll pay a daily coinsurance from days 61 to 90. Then, you’ll begin using your lifetime reserve days, which have their own daily coinsurance. In 2020, these costs are:
2020 Part A Inpatient Costs Breakdown
Inpatient Hospital Deductible $1,408
Daily Coinsurance for Days 61 to 90 $352
Daily Coinsurance for (90) Lifetime Reserve Days $704
Outpatient Physical Therapy
- This is when you need the service, but don’t require the supervision or intensive, coordinated care that would make inpatient treatment necessary.
- Your doctor must certify that the therapy is medically necessary to receive coverage. If it is covered, it’ll be covered under Medicare Part B.
- Medicare may cover 80 percent of the approved cost for your therapy.
- The Medicare Part B deductible also will apply for this treatment.
Extra Coverage
- If you have Medicare Part C, also known as Medicare Advantage, you may get additional coverage on top of what Original Medicare would normally cover.
- Medicare Advantage plans must cover the same services as Original Medicare.
- Medicare Supplements (Medigap plans), can cover many of your out-of-pocket costs (the 20% coinsurance and annual deductibles) that Original Medicare doesn't cover. Of course, it will depend on which Medigap plan you chose (Plans A - N) that will determine how much of the ( 20% coinsurance and annual deductibles) that will be covered.
