Physical therapy is an essential healthcare service for seniors, especially those who are looking to maintain mobility or are managing chronic conditions. The same is true for people with certain disability. As such, for many participants of the Medicare program, it is important to understand what kind of physical therapy services are covered by their insurance plans.
In this blog, we will discuss “Does Medicare covers physical therapy”, as well as the benefits and costs associated with the therapy sessions. We will also show you the differences between Original Medicare and Medicare Advantage plans, and how the latter can potentially provide additional coverage that’ll include physical and occupational therapy.
Are Physical Therapy Services Covered by Standard Medicare?
Medicare is the program set up by the Federal Government to provide affordable medical insurance to individuals aged 65 above, as well as younger people with certain disabilities. Standard Medicare coverage provides a wide range of medical services, when it comes to physical therapy, there are plenty of limitations that Medicare beneficiaries need to be aware of. Below we will walk you through which components of Medicare may cover physical therapy services.
Medicare Part A -- Inpatient Physical Therapy Sessions
Medicare Part A mainly covers inpatient hospital care, certain skilled nursing facility care, and home health services. While it may cover physical therapy sessions in some situations, such as when the patient is receiving therapy during rehabilitation following a hospitalization, Part A normally doesn’t cover outpatient physical therapy sessions.
Medicare Part B -- Outpatient Physical Therapy
Medicare Part B covers medically necessary outpatient services. These can include doctor visits, preventive care, and certain outpatient therapy services. While physical therapy is included in the coverage of Part B, there are specific requirements and limitations — it only covers services that are deemed medically necessary to diagnose or treat a medical condition.
If your doctor or another qualified provider confirms that you require skilled therapy services, Medicare Part B provides coverage for outpatient physical therapy, occupational therapy, and speech-language pathology. However, your doctor or therapist is required to develop a care plan and review it regularly.
Part B typically covers up to 80% of the approved amount for outpatient physical therapy. The remaining 20% will have to be covered by the patient through coinsurance or supplemental insurance.
Important Note: There is no max out-of-pocket limit for expenses with standard Medicare.
Common Types of Physical Therapy for Seniors
As explained above, physical therapy can be critical in helping seniors maintain or regain their mobility, manage chronic conditions and pain, as well as improve their overall well-being. Here, we will explain the different types of physical therapy available, with each designed to address specific needs and conditions.
Orthopedic Physical Therapy
Orthopedic physical therapy focuses on the assessment, diagnosis, and treatment of injuries and conditions related to the bones, muscles, ligaments, and tendons. Its goal is to help patients recover from orthopedic injuries, surgeries, or conditions affecting the musculoskeletal system. It is especially effective for seniors who are recovering from fractures, joint replacements, or sports injuries.
Geriatric Physical Therapy
Geriatric physical therapy is specifically designed to focus on the assessment, treatment, and rehabilitation of older adults. This branch of physical therapy addresses the unique needs and challenges faced by seniors as they age, targeting issues such as arthritis, Alzheimer’s disease, hip replacement recovery, and other age-related challenges. Its main focuses are enhancing mobility, flexibility, and overall physical well-being.
Neurological Physical Therapy
Senior living with neurological conditions such as stroke, Parkinson’s disease, multiple sclerosis, or Alzheimer’s disease can benefit greatly from neurological physical therapy. It can help manage symptoms associated with these conditions, such as muscle weakness, spasticity, balance problems, gait disturbances, and cognitive impairments.
Cardiovascular or Pulmonary Rehabilitation
As people age, the risk of cardiovascular diseases such as heart disease, hypertension, and stroke increases. Cardiovascular or pulmonary rehabilitation is essential for seniors living with these disorders.
This type of therapy helps seniors manage these conditions through exercise and and interventions that improve cardiovascular endurance, lung capacity, and overall respiratory function. It aims to enhance the senior’s ability to live independently and improve their overall cardiovascular health.
Wound Care Therapy
Seniors may be more susceptible to developing wounds due to fragile skin, decreased mobility, poor circulation, and underlying health conditions like diabetes or vascular disease. Proper wound care therapy helps facilitate the proper healing of wounds in seniors, preventing complications such as infection, delayed healing, and tissue damage, which can lead to serious consequences. By promoting adequate oxygenation and blood flow to the affected area, this therapy helps wounds heal more efficiently. It also focuses on preventing infections and minimizing scarring, ensuring optimal recovery.
Vestibular Therapy
Seniors are more susceptible to balance disorders due to age-related changes in the vestibular system, vision, proprioception, and musculoskeletal function. The resulting dizziness, vertigo, or unsteadiness can be addressed by vestibular therapy, which aims to improve balance, reduce falls, and enhance overall stability.
What are the Limitations of Medicare Part B Coverage?
As mentioned above, the coverage of Medicare Part B on physical therapy services comes with certain limitations. Some examples include the restrictions on the number of therapy visits covered per year, as well as the duration of each session.
Additionally, you may be required to obtain prior authorization from Medicare for physical therapy services, while the physical therapist you choose must also be Medicare-approved.
What About Medicare Advantage Plans?
Medicare Advantage plans (MA plans), also known as Medicare Part C, are alternatives to traditional Medicare which offer additional benefits beyond what Part A & B (Original Medicare) normally cover. They are offered by private insurance providers approved by Medicare.
As with other medical services, Medical Advantage plans can potentially offer enhanced coverage of physical therapy services beyond what the Original Medicare provides. They may also offer options such as lower co-payments or coinsurance for physical therapy visits, coverage for a higher number of therapy sessions, or even coverage for alternative therapies like acupuncture or chiropractic services.
If you are looking for comprehensive coverage for physical therapy, one way to learn more about the specific details of different Medicare Advantage plans so you can make informed decisions is to speak with a licensed agent.
Just remember, while standard Medicare offers some coverage for physical therapy under Part B, there are restrictions and your potential out-of-pocket costs can also be quite high. By evaluating the additional options provided by Medicare Advantage plans, you will have a better chance of getting the right coverage to meet your physical therapy requirements.
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