Physical Therapy and Medicare Coverage
Medicare Part A
Medicare Part A can cover some of the cost of physical therapy at either an inpatient facility or your home. The longevity of the treatment, as well as your deductibles and other payments, are taken into consideration when calculating the overall costs of physical therapy.
Keep in mind that Medicare will only pay for services that are “reasonable and necessary” as deemed by your primary care provider. Medicare Part A covers inpatient stays at settings such as rehab centers or skilled nursing facilities.
Medicare Part B
Since there are no annual caps, Medicare Part B covers medically necessary services that are certified by a doctor or physical therapist. This could include outpatient therapy, occupational therapy, physical therapy, or other forms of therapy in an outpatient setting to alleviate, treat, or prevent conditions. Care can be administered at skilled nursing facilities or provided at home or other outpatient facilities.
Most Medicare Advantage or Medicare Part C plans provide additional coverage that other parts of Medicare (Parts A and B) might not typically cover. For example, Medicare Advantage can cover physical therapy so long as you pay the 20 percent after you meet your Part B deductible, which is $226 in 2023.
If your physical therapy is not medically necessary, you will have to pay the full cost of the treatment.
Medigap, or Medicare supplemental insurance, covers the cost that might not be covered by Parts A and B. You may want to check with your plan to see what’s covered and what you’d have to pay out of pocket. Medigap plans will always cover what Medicare covers, including the 20 percent coinsurance. Some plans will even pay your Part B deductible.