February 12th 2024
By Ari Parker
Understand Medicare coverage for physical therapy, and see which seniors are eligible for this important treatment in this article.
By Ari Parker
Physical therapy helps over 50 million Americans every year overcome obstacles related to mobility, flexibility, and strength. Not only can physical therapy increase your endurance after an injury, it can also help you feel like yourself again.
A single physical therapy session can cost up to $350 or more. Fortunately, Medicare covers physical therapy if your healthcare provider says that you need it. We’ll help you understand what services are covered, how many sessions of physical therapy Medicare can cover, and what out-of-pocket expenses to expect for physical therapy.
Medicare helps cover physical therapy sessions when they’re medically necessary to treat a condition or recover from an injury. A healthcare provider must create a treatment plan for you.
Medicare Advantage plans can be more restrictive with physical therapy. Out-of-pocket costs can vary depending on your insurance, whether you’re in-network, or whether or not you have prior authorization.
Physical therapy is a kind of care that focuses on rehabilitation, usually for mobility or to ease pain. It helps people move better and feel less pain. Physical therapists use exercises, hands-on methods, and education to improve strength, flexibility, and overall health. People use physical therapy to manage chronic conditions like Parkinson’s disease or to help recover from a fall, stroke, or surgery.
Take a look at some common services for physical therapy below.
Exercise programs: Physical therapy can involve tailored exercises to improve mobility, strength, flexibility, and endurance based on your specific needs and conditions.
Manual therapy: A therapist can use hands-on techniques such as massage therapy, joint mobilization, and manipulation to relieve pain and enhance mobility.
Electrotherapy: In some situations, therapists use electrical stimulation to relieve pain, promote healing, and improve muscle function.
Hot and cold therapies: You may see some physical therapy techniques that involve applying heat or ice to manage pain, reduce inflammation, and enhance tissue healing.
Education and counseling: Therapists provide guidance on understanding and managing conditions. They can also give you specific treatment plans to reach goals and prevent future injuries.
Assistive devices: Physical therapists may use or recommend mobility aids or assistive devices, like crutches, walkers, or braces.
Posture and body mechanics training: Therapists can teach or re-introduce proper body function and posture to prevent and relieve musculoskeletal issues.
Functional training: If you have mobility issues, physical therapists help with activities and exercises that mimic daily tasks so you can improve your ability to perform everyday activities.
Yes, Medicare covers physical therapy when the service is medically necessary.
Most people need physical therapy in an outpatient setting. Medicare Part B helps take care of the costs for outpatient physical therapy in:
A doctor or physical therapist’s office
Outpatient rehabilitation facility
A hospital’s outpatient office
Once you reach your Part B deductible ($257 in 2025), Medicare covers 80% of the service. You’ll have to pay 20% of the out-of-pocket costs, which includes copays and coinsurance. If you have a Medicare Supplement plan, it will reduce your out-of-pocket costs.
You can also receive physical therapy in a skilled nursing home, inpatient/hospital setting, or home health setting if you need long-term care. In this case, Medicare Part A would cover the service. For the first 60 days you’re in an inpatient setting, Medicare Part A would pay 100% of the physical therapy bill after you meet your Part A deductible ($1,676 in 2025). If you need additional care after 60 days, Medicare charges you a daily coinsurance of $419. A Medigap plan can also help you cover some of these out-of-pocket costs.
Medicare Advantage plans cover the same services as Original Medicare, so they also cover physical therapy. However, Medicare Advantage plans don’t have to standardize their out-of-pocket expenses like copays and coinsurance in the same way that Original Medicare does. This means that you may have to pay more or less for physical therapy out of pocket, depending on your specific policy.
Medicare Advantage plans can be more restrictive with inpatient services. If the hospital you stay at is out of network, you may have to cover the costs of physical therapy yourself.
Lastly, Medicare Advantage plans require prior authorization more often than Original Medicare. They can be strict about who gets prior authorization. If you’re denied, you’ll have to appeal the denial or pay for physical therapy yourself.
You can receive as many physical therapy sessions as your doctor says you need. Medicare covers the cost of all medically necessary outpatient therapy services. How many physical therapy sessions you’ll need will depend on the treatment plan that your healthcare provider recommends.
Your healthcare provider needs to create a treatment plan for you before Medicare will cover the sessions. Medicare checks in on your sessions from time to time to make sure that your physical therapy is still medically required. Your therapist or other provider is responsible for reviewing and relaying the information to Medicare.
Medicare pays special attention if the cost of your treatment plan is more than $2,110. Especially for this situation, your team of healthcare providers have to certify that you need the therapy for recovery. Common situations where you might exceed $2,110 for physical therapy include:
You are involved in a car accident or other serious emergencies that cause injury.
You have a neurological disorder like Parkinson’s that affects your ability to move.
You have a chronic health condition like osteoporosis or osteoarthritis.
Medicare covers the following therapy services in the same way that it covers physical therapy:
Occupational therapy: helps people with physical, developmental, or cognitive impairments develop or regain skills for daily activities
Speech-language pathology: treats people with a variety of communication and swallowing disorders
Mental health counseling or behavioral therapy: helps people with emotional, psychological, or behavioral challenges
Physical therapy is a necessary service for many people facing mobility issues or who need help recovering from an injury. Any concerns about paying for medical bills are completely valid. Our team of dedicated Advisors can help you understand how Medicare will pay for your physical therapy sessions. Chat with a licensed Advisor today at 855-900-2427 or schedule a call to get your questions answered and the support you need.
