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What Is Medicare?

Medicare is in place to help it’s policyholders pay for any medically necessary services a doctor orders to treat conditions. Medicare is a system of health insurance that is coordinated by the federal government for people age 65 years and older, as well as certain people under the age of 65 who have disabilities.

There are a few different types of Medicare programs, which have provided health insurance for up to 59 million individuals or more, depending on the year.

Types Of Medicare Plans

Medicare is divided into four parts, including Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Each of these programs covers different things, and as a policyholder, you will want to be well researched so that you know what health insurance coverages you have and what they provide.

Medicare Part A covers hospital expenses, skilled nursing, and hospice services. Medicare Part B covers outpatient services, including prescription drugs that are administered by a medical professional. Medicare Part D is a portion of Medicare that covers self-administered prescription drugs. Medicare Part C includes at least the same services as Parts A and Parts B, in some cases the insurance benefits of Part D, and also have an annual spend limit for out of pocket expenses the other plans can sometimes lack.

Does Medicare Cover Physical Therapy?

When physical therapy services are medically necessary and ordered by your doctor, they are generally covered under Medicare Part B. This means that in most cases, they are also covered by Medicare Part C. The benefits are the same for other medically necessary therapy types, including occupational therapy and speech therapy.

If you are planning to claim physical therapy, be aware that your healthcare provider will need to provide additional information to your medical record if your therapy charges reach a certain amount. The amount for physical therapy and speech language pathology services combined is $2,010. For occupational therapy services, the number is also $2,010. After this, your doctor will need to record why continuing the services is both reasonable and medically necessary.

People who have a Medicare Advantage plan, or Medicare Part C, may have slightly different therapy benefits listed in their policy. Private insurance companies offer these plans, and these companies may choose to provide additional services and benefits above and beyond those that Part A and Part B have. Discussing your insurance needs with a health insurance company administrator can give you a better idea of what is covered in terms of physical therapy in Medicare Advantage plans.

Keep in mind that whether or not physical therapy is covered under your Medicare plan depends on whether or not the treatment is medically necessary. If the cost of treatment is reasonable in relation to a patient’s chances of reaching a level of relief that is desirable, or provides functional improvement, it may be covered by your Medicare plan. Even if the treatment mitigates a patient’s risk of suffering a worse outcome, specifically if the current condition is left untreated, the physical therapy recommended may be covered by your Medicare plan.

The best way to know if physical therapy is covered by Medicare is to communicate with your policy administrators. Also, make sure to read your health insurance policy thoroughly. When it comes to Medicare and physical therapy, research is critical. Pro Care PT is here to assist.