Your Medicare Part B part of your Medicare plan covers outpatient physical therapy that is deemed medically necessary. Your Part B deductible still applies, and you are still required to pay 20% of the Medicare-approved amount.
You may receive outpatient services at locations such as:
- doctor’s or therapist’s office
- hospital outpatient departments
- outpatient rehabilitation facilities
- skilled nursing facilities if you are being treated as an outpatient
- at your home, if a Medicare-certified home health agency is providing it and Medicare Part A does not provide coverage
*You should consult your doctor about the cost of your services due to other factors that may affect your coverage.
Your Medicare Part A coverage will help pay for any inpatient physical therapy you may require for treatment. Part A may also cover services at a skilled nursing facility or at-home treatment if you experienced a hospital stay that lasted at least three or more days. Out-of-pocket costs and coinsurances are determined by the services provided and how long they occur. The difference between coverage determination is whether a patient was hospitalized for at least three days or not. Medicare Part A requires hospitalization to cover physical therapy; Medicare Part B does not.
Medicare Physical Therapy Benefits
Basically, your Medicare Part B plan will cover any outpatient physical therapy services prescribed by your doctor as treatment for your condition. The benefits you receive are partially determined by where you choose to receive coverage. Your physician usually prescribes these services to help restore your normal physical function and help prevent impairments that could have resulted from an injury, disease, or other condition.
If your physical therapy services are required at home, then Medicare Part A and/or Part B home health benefits will possibly cover 100% of the allowable charges, as long as you meet the following conditions:
- you must be under a doctor’s care, and your physical therapy must be part of your care plan
- your doctor must certify you as homebound
- treatment must be received by a qualified physical therapist
- the home health agency providing services must be Medicare-certified
- your doctor deems physical therapy will improve your condition or help stabilize it and keep it from worsening
Medicare physical therapists usually will not cover sporadic or part-time treatment.
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Having the proper coverage is important. That’s why at Carolina Senior Benefits, our goal is to help you get the Medicare coverage you need. For more information or to schedule an appointment, call us today!