A Patient's Guide to Physical Therapy and Medicare Health Insurance
Confused about the kind of coverage your health insurance has to offer? Trying to find a way to check if insurance covers your physical therapy needs? These are common questions asked by our patients looking to understand what their health insurance covers.
Fortunately, most insurance plans cover medically required physical therapy services. However, these services are only to be performed by a licensed physical therapist. To help you out we have listed a few options you have available, and how you can take full advantage of your health insurance.
Medicare A covers for services received when you are in a hospital, and the services required after hospitalization. These cover treatments for individuals who are homebound or are unable to access services offered in the community. Here is what is covered:
- Inpatient care hospital, rehab, or skilled nursing facility
- Home health services and Home Health PT
- Hospice care
Medicare B includes medically required outpatient physical therapy services. The term "Medically Required" means a physician has certified that you need skilled physical therapy. This covers impairments and limitations caused by injury or illness. Even so, Medicare B covers 80% of the cost, the rest is covered by you or your supplement plan. Essentially there is no cap on how much Medicare will pay annually for therapy, as long as the treatment is medically required and you are working towards a certain goal. However, Insurance won’t pay if services are not proven to be skilled, reasonable and necessary. This coverage pays for treatments offered by:
- Outpatient Rehab
- Mobile Physical Therapy (Like LK Fitness & Therapy Provides)
Once Coverage Ends
Once you have met your Therapy goals Medicare B stops covering your physical therapy services. This is when you can either continue on your own with a home exercise program or continue with private pay Wellness/ Fitness programs. (These Services are also offered by LK Fitness & Therapy, LLC) The options vary from one therapist to another but offer great results. Another option is to join the local gym or exercise class, as it allows you to stay active and maintain your progress.
Services Not Covered By Insurance
Physical Therapists offer services that might not be covered under your insurance. These are usually fitness and wellness plans, sport specific programs, health & education classes, and other prevention programs. These are the added extras that offer great help to individuals but have to be paid out of pocket. To learn more about their coverage you can ask your physical therapist, discussing your plan can ensure you take the best possible route. One that covers your costs, and offers maximum benefits in the long run.