Having a physical disability is always challenging. So you need to have comprehensive physical therapy to get the best outcome for your health. However, while your doctor may prescribe physical therapy, you may not have the ability to pay for these sessions. Therefore, it is important to find affordable physical therapy and expert medical professionals. Are you asking: “How do I find a physical therapist who takes Medicare near me?” Then keep reading for more information.
Medicare Coverage of Physical Therapy
How much does your physical therapy cost with Medicare? Under this program, patients pay 20% of their Medicare-approved amount for physical therapy. But if your physical therapist charges over this limit, then you’ll have to pay the difference.
However, since physical therapy services are covered under Part B, you can also use the Part B deductible. In 2020, the Part B deductible is $198 per year (an increase from $185 the previous year). So you’ll need to pay $198 out of pocket each year before Medicare will begin paying its percentage of your physical therapy costs.
Please note that if you have Medicare Advantage (and not the Original Medicare insurance), then your costs will vary. It all depends on the plan you select. We recommend that you check your plan provider for your plan’s details.
Are Referrals Necessary?
Since you have direct access, many Medicare patients may get physical therapy before getting a referral from their physician. While the Medicare program doesn’t require patients to visit their physician, some physical therapy practices may require an office visit before signing off on a plan of treatment.
Exploring Medicare Physical Therapy Benefits
Medicare will help to pay for any medically necessary physical therapy services that your doctor orders for your recovery. But your Medicare physical therapy benefits strongly depend on where you access these services.
Medicare Part B usually covers physical therapy services. If you get these services at a hospital, an outpatient center, or in your doctor’s office, then Part B takes care of 80% of allowable charges (after you pay your Part B deductible). The good news is that these benefits are the same for other medically necessary therapies like occupational therapy and speech-language therapy.
If you need physical therapy at home, you’re still covered. Your Medicare Part A and/or Part B home health benefits may cover 100% of the allowable charges. To get Medicare physical therapy benefits at home, you need to meet all of these conditions:
- You need to be under a doctor’s care. Furthermore, your physical therapy must be a part of a treatment plan that your doctor reviews regularly.
- Your doctor must certify you as being homebound.
- The physical therapy sessions must be performed by a qualified physical therapist. Do you need help to find a physical therapist who takes Medicare near you? Then you can use the Medicare Physician Compare tool.
- You must use a Medicare-approved home health agency for your physical therapy.
- Your doctor must indicate that your condition can be reasonably improved or maintained with physical therapy.
How Long Does Medicare Cover In-Home Physical Therapy?
Your Medicare physical therapy benefits usually don’t cover home health services that are more than part-time or intermittent.
If you qualify for physical therapy home health care, you pay nothing for your therapy services. Also, you only pay 20% of the allowable charges for any durable medical equipment you may need for your treatment.
Medicare enrollees are approved for in-home care under Parts A and B if the following requirements are met:
- The patient is under the care of a doctor who regularly reviews their treatment plan.
- A doctor certifies that a patient needs physical therapy or other medical services.
- The patient only needs physical, occupational, or speech therapy for a short time.
- A doctor certifies that a patient is homebound.
- The use of a Medicare-approved home health agency.
Are There Any Caps on Medicare-funded Physical Therapy?
Medicare used to impose a yearly cap on the amount of physical therapy you could access. The costs of physical therapy, occupational therapy, and speech-language therapy would all contribute to this annual therapy cap.
However, Congress eliminated these therapy caps in 2018. Now there is no specific limit on the amount of physical therapy you can get in a calendar year. However, your healthcare provider has to indicate why the services are reasonable and medically necessary when your charges exceed certain thresholds. These thresholds are:
- $2,010 for physical therapy and speech-language therapy combined
- $2,010 for occupational therapy services
If you continue to receive physical therapy services beyond these amounts, then Medicare may review them once they reach $3,000 for any of the three main therapy categories. The downside is that Medicare may decide not to cover any extra services if your doctor didn’t give sufficient info to justify the continued therapy.
If this happens, your healthcare provider or therapist must give you a notice about the cessation of your Medicare benefits for the year. This is called an Advance Beneficiary Notice of Noncoverage (ABN). If you get an ABN from your provider, you have two choices. You can either end your physical therapy or continue with your treatments and pay for them out of pocket.
What’s the Difference Between Medicare and Medicare Advantage?
Your physical therapy benefits differ a bit under the Medicare Advantage plan. These Medicare Advantage plans give you the same level of benefits as Original Medicare. However, since these plans are provided by private insurance companies, they may be able to offer more extra benefits in addition to those given by Plan A and Plan B. We recommend that you contact your Medicare Advantage administrator to know what documents you need to submit to access physical therapy services.
Get the Physical Therapy You Need!
You no longer have to ask: “ How do I find a physical therapist who takes Medicare near me?” At Moving With Hope, we accept Medicare. Furthermore, we provide affordable physical, occupational, and speech-language therapy sessions.
We leverage the best and most experienced healthcare professionals, adaptive exercise, evidence-based research, and innovative equipment to give you the long-term support that you need. Moving With Hope empowers survivors, strengthens communities, and gives hope. Contact us today to find out how we can serve your physical therapy requirements.