How Much Physical Therapy Does Medicare Cover?

How Much Physical Therapy Does Medicare Cover?

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Original Medicare and Medicare Advantage both pay for physical therapy when ordered by a doctor. Medicare Advantage offers the same benefits at a lower cost, making it a better health insurance option compared to Original Medicare.

Medicare Advantage plans save you money on your out-of-pocket physical therapy costs compared to Original Medicare. When searching for health insurance, we suggest Medicare Advantage plans as a first option.

Does Medicare cover physical therapy?

Medicare pays for physical therapy in both inpatient and outpatient settings. What you pay toward therapy depends on the type of Medicare plan you have and where you receive services.

Original Medicare covers physical therapy in two ways. Medicare Part A, or hospital insurance, pays for treatment you get in an inpatient rehabilitation or skilled nursing facility. When you go to an outpatient setting such as a doctor's or therapist's office, Medicare Part B (medical insurance) covers the services. You are responsible for deductibles and coinsurance charged under both Part A and Part B.

Medicare Advantage policies also pay for inpatient and outpatient physical therapy. Costs and coverage vary, and your plan may require referrals and preauthorizations for therapy services.

Does Medicare cover physical therapy in a hospital or rehabilitation facility?

Medicare pays some or all of the cost of physical therapy you receive at an inpatient rehabilitation facility.

Medicare Part A covers medically necessary physical therapy received at an acute care rehabilitation center, rehabilitation hospital or inpatient rehabilitation or "rehab" facility. Treatment is often used to help you recover from a serious injury or illness. To be eligible for payment, your doctor must certify that inpatient physical therapy is needed.

How much will I pay for inpatient physical therapy under Original Medicare?

When you receive physical therapy in an inpatient rehabilitation center, it's included in the overall cost of your stay and is subject to the standard Medicare Part A cost structure.

During days 1 through 60 in a hospital or rehab facility, you'll pay the Medicare Part A deductible unless you already paid it within the current benefit period. After day 60, you pay coinsurance based on the length of your stay.

inpatient physical therapy costs
Days
How much you pay
Additional notes
1-60$1,556 deductibleUnless you’ve already met your deductible in this benefit period
61-90$389/day coinsurance
91+$778/day coinsurance for each "lifetime reserve day"You have 60 of these over your lifetime. Each day after your 60 lifetime reserve days (beginning at day 152), you will be responsible for all costs.

If you paid your deductible during a hospital stay and then went to the rehab facility within 60 days, you won't have to pay your deductible again.

Physical therapy is just one portion of your overall care during a hospital stay. While you're there, Medicare covers your therapy along with other typical hospital costs such as:

  • A semiprivate room
  • Meals
  • Medications
  • Nursing services
  • Other hospital services and supplies

Does Medicare cover physical therapy in a skilled nursing facility?

Medicare covers physical therapy in a skilled nursing facility when your doctor prescribes it. To enter a skilled facility, you must have had a hospital stay of at least three days and be admitted within 30 days of discharge from the hospital.

Medicare pays for the first 20 days of a skilled nursing stay in full, including any physical therapy you receive there. For days 21 through 100, you pay a daily coinsurance of $194.50. Starting with day 101, you're responsible for the full cost of your services.

Does Medicare cover physical therapy in a doctor's office or another outpatient setting?

Medicare Part B pays for physical therapy you receive in outpatient settings such as:

  • A doctor’s or therapist’s office
  • Hospital outpatient departments
  • Outpatient rehabilitation facilities
  • Skilled nursing facilities if you are treated as an outpatient

There is no limit to how much Medicare will pay for outpatient therapy. After your Part B deductible, you pay 20% of the Medicare-approved amount for each service. A doctor must order your treatment, but you don't need a qualifying hospital stay to receive outpatient physical therapy.

If you get physical therapy without a doctor's order, Medicare normally won't cover it. In that case, your therapist must give you a written notice called an Advance Beneficiary Notice of Noncoverage (ABN) stating that Medicare may not pay for the service. If you choose to go ahead with the therapy, you are agreeing to pay in full.

Does Medicare cover physical therapy at home?

Yes, Medicare covers physical therapy at home under the home health care benefit. This is when a home health agency coordinates home health services ordered by your doctor. Since Medicare pays for home health care in full, physical therapy received as part of home health services is also covered in full. As a result, you won't pay a Medicare deductible or coinsurance for physical therapy received under the home health benefit.

How many physical therapy sessions does Medicare cover?

Medicare does not limit the number of physical therapy sessions you can receive and covers outpatient therapy for as long as you need it. But there is a maximum benefit for inpatient therapy depending on where you receive services. For instance, after 151 days at an inpatient rehab facility, you pay for all charges, including physical therapy. When you receive care at a skilled nursing facility, you pay the cost of all services beginning on day 101.

How do Medigap plans cover physical therapy?

Your Medigap plan pays for physical therapy costs left over after Medicare pays. With inpatient physical therapy, you're responsible for the Medicare Part A deductible, which is fully or partially covered by your Medigap plan. The one exception is Medigap Plan A, which does not cover any part of the Part A deductible.

Medicare Part B pays for physical therapy you receive in an outpatient setting like a doctor's or therapist's office. After you meet your deductible, Medicare Part B pays 80% and Medigap covers all or part of what's left, depending on your plan.

When physical therapy is done as part of home health services, you are not subject to any Medicare deductible or coinsurance. That means there would be no out-of-pocket costs to file with your Medigap plan.

Does Medicare Advantage cover physical therapy?

Medicare Advantage plans must include at least the same physical therapy benefits as Original Medicare. But Medicare Advantage policies manage costs differently than Original Medicare, making Medicare Advantage the cheaper option for physical therapy. Plan prices and coverage vary, so review policy documents carefully to find an option that fits your needs and budget.

Best Medicare Advantage options for physical therapy

We reviewed several Medicare Advantage plans and found two plans that stand out based on out-of-pocket costs for physical therapy. These insurers each offer Medicare products in almost every state and have large Medicare provider networks.

AARP/UHC: Best overall plan
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Humana: Affordable physical therapy
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Another good option for physical therapy is Blue Cross Blue Shield, which has one of the largest provider networks and is widely available.

Our review focused on Medicare HMO plans. With an HMO, you generally must obtain preauthorizations or referrals for specialty services, including physical therapy. You also may be limited to in-network physical therapy providers.

Below are out-of-pocket costs for three Medicare Advantage plans offering the best physical therapy benefit. The inpatient hospital column reflects the cost for a single hospital admission, no matter how long you are there. The skilled nursing facility figure is what you would pay for a 100-day stay.

Each of these plans earned 4 of 5 stars in the CMS quality rating system.

Medicare Advantage plan
Outpatient
Inpatient hospital
Skilled facility
AARP/UnitedHealthcare (UHC)$0 copay per visit$0 per admission$940
Humana$0 copay per visit$0 per admission$4,000
Blue Cross Blue Shield$10 copay per visit$500 per admission$8,000

Frequently asked questions

How can I find out if Medicare will cover my physical therapy?

If you have questions about physical therapy coverage or costs, you can call Medicare at 800-MEDICARE (800-633-4227). TTY users can call 877-486-2048. You also can contact your State Health Insurance Assistance Program (SHIP) for free health insurance counseling.

Does Medicare cover physical therapy for back pain?

Medicare covers physical therapy for back pain and other health issues as long as a medical doctor orders the services.

Which Medicare Advantage plan offers the cheapest physical therapy?

UnitedHealthcare provides physical therapy benefits at the lowest cost of all plans we reviewed. You pay nothing for outpatient therapy visits or an inpatient hospital stay. Your expense for a 100-day stay at a skilled nursing facility would be $940 — about one-fourth the cost of the second-cheapest plan.

Methodology

Our policy recommendations are based on selections that provide physical therapy coverage at the lowest cost. Medicare quotes and plan details were sourced from AARP/UnitedHealthcare, Blue Cross Blue Shield and Humana. We also reviewed plans available from Aetna, Cigna and Kaiser Permanente. Additional sources include Medicare.gov and CMS.gov.

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