Does Medicare Cover Physical Therapy?

Learn if Original Medicare covers physical therapy

by Amy De Vore+ on Apr 02, 2018 | 19 Comments

Physical Therapy is an alternative treatment before and after surgery to help heal and prevent further injury, as well as, care after a serious illness, such as stroke. Physical therapy costs can really add up, especially if you need care for a long period of time. The question is does Medicare cover it, and, if so, how much does it cover?

Does Medicare Cover Physical Therapy?

Yes. You are still responsible for your Medicare Part B deductible, your 20% coinsurance and any excess charges.  At one time there was a maximum payout for physical therapy but that was removed by Congress for 2018. 

Does Medigap Cover Physical Therapy?

All Medigap plans pay for all or part of your physical therapy coinsurance and copays, however only only Medigap plans “C” and “F” cover your Part B deductible. Plans F and Plans G will cover all excess charges as well.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Physical Therapy?

Medicare Advantage (MA) does cover physical therapy, however, since MA plans are not standardized you’ll have to research exactly how.

Learn More about Medicare AdvantageGet a MA Quote

For further questions call a Senior65 agent at 800-930-7956 or click here to read our article Does Medicare cover Chiropractic and Acupuncture?

 

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Reader Comments and Questions

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By Suzanne on April 26, 2018

My husband broke his hand and had surgery wto replace a broken bone PT was requested has been gling but was advised at his visit yesterday that medicare will no longer pay. His secondary is tricare for life. What does he have to do to continue PY.

Suzanne,
Tricare is manage via the Veterans Administration. You will want to contact the VA directly at 1-877-222-VETS (8387).
-Eric at Senior65.com


By Laffy on July 17, 2017

I wrote last week to ask if medicare approved chiropractic referrals foe physical therapy. I never had a reply.

Laffy,
Generally speaking, physical therapy needs to be referred by a doctor of medicine. However, as always, we suggest contacting Medicare to find out how and if a service is covered. Best of luck!
-Amy from https://www.senior65.com/


By Sharon DelPinto on March 12, 2017

If I met my deductible for part b can a physical therapist charge me a co payment. I only have original Medicare and am 65 on ssd.

Sharon,
Yes, your physical therapist can require a copayment and/or coinsurance. You will want to speak to Medicare and your physical therapist to see what you'll owe.
-Amy from https://www.senior65.com/


By Sharon Mcilwain on February 27, 2017

I have degenerative disc disease and spondylitis Bulging discs causing pinched nerves with numbness in my feet. According to recent MRI. I. Having PT now which is helping slowly . Also aqua therapy, in May I am getting a knee replacement. Will my Medicare and supplement pay for this. Thanks for any help with this

Sharon,
Without knowing which Medicare Supplement plan you are enrolled in, we couldn't say how your plan would cover you; however here's a Medigap comparison chart to see how each lettered plan fills in the gaps of Original Medicare. To confirm if/how your physical therapy, aqua therapy, and knee replacement are covered by Medicare, you'll want to call them directly.
-Amy from https://www.senior65.com/


By Bill on January 13, 2017

Is PT given by doctor of chiropractory covered under medicare?

Bill,
If your chiropractor is also a licensed physical therapist that accepts Medicare assignment, you should be fine. You will want to speak with Medicare and your physical therapist to confirm.
-Amy from https://www.senior65.com/


By Strephon Johnson on December 09, 2016

My wife's referral notes "Diagnosis: Dementia without behavioral disturbance, unspecified dementia type". She is 75 years old. Would the specialist's charges be covered by her Medicare? S. Johnson

S. Johnson,
As long as your wife's specialist accepts Medicare-assignment she should be covered. For specific Medicare questions about coverage, we suggest you contact them directly.
-Michelle from https://www.senior65.com/


By Carolyn Walton Gibson on October 31, 2016

My doctor referred me to a physical therapist. Will my Medicare Advantage plan cover the costs of my physical therapist visits?

Carolyn,
Your Medicare Advantage plan most likely will not cover all of your physical therapy costs, you might have a copay, coinsurance, and/or a deductible that you'll owe. You will want to check with your provider to see how exactly they cover your costs.
-Amy from https://www.senior65.com/


By Saundra on September 30, 2016

I had an attack of full blown vertigo and in the interim I lost a nerve that affected my balance from my right ear. I am going to vestibular rehab therapy that my ENT Dr sent me to but it is so far. By the time I get there I am exhausted and after therapy the drive home is tiring. Can I change and continue my therapy at another therapist that is much closer to my home that provides the same services or do I have to remain where I am going currently. I have had only 3 visits and was told i would need at least 18. I have medicare B and supplemental uns with Anthem Blue Cross blue Shield. thank you

Saundra,
With Medicare and Medicare Supplement, you do not need a referral to see a doctor/specialist. So feel free to see a doctor closer to home. For the limited visits, you will want to ask your doctor to write a letter to Medicare requesting the extend your cap on coverage. Hope this helps!
-Amy from https://www.senior65.com/


By Cathy Rierson on September 16, 2016

My doctor my severe ankle pain as posterior tibial tendinitis and told me to get orthotics. They cost $600, and are not covered by any insurance. He also wrote a prescription for physical therapy 2/3 times per week for 4 weeks. I have Medicare part A and B and have only been on it for about a year. I also have a supplemental insurance. Will the physical therapy be covered?

Cathy,
Thank you for your question. Yes, physical therapy is covered by both Medicare and Medigap. In the above article it explains the cap on coverage.

If you need help finding another Medigap plan, please contact one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By kathie garton on August 23, 2016

do i qualify or outpatient pt under medicare part b if i received outparient pt billed under blue cross? i had a stroke a year ago

Kathie,
If you are enrolled in Medicare Part B, physical therapy is covered with the cap listed in the above article. If you are interested in enrolling in a Medigap or a Medicare Advantage plan to help lower your out of pocket costs, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Eric from https://www.senior65.com/


By Debra on May 25, 2016

I have MS and standard Medicare but need PT/$100/hr ... would a sup plan help me pay for PT?

Debra,
Medicare Supplement (Medigap plans) can pay all or part of your physical therapy costs, up to the Medicare cap (listed above in the article). For help finding a Medigap plan in your area, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Patricia A. Stepken on March 08, 2016

Good morning, I have Fed Blue Cross/Blue Shield coverage which does not cover my co-pays. Due to several falls I was receiving pt for balance issues. My co-pay is $35.00 per visit. I discontinued therapy before i reached the prescribed number of visits because i am retired and on fixed income and cannot afford pt co-pay. i am 71 years old. will medicare cover my co-pays and will there be consequences for discontinuing therapy without dr release and/or pt release? thank you for your attention to these questions.

Patricia,
We would need a little more information to answer your questions. But I will tell you that Original Medicare does not cover copays. If you are interested in a plan that does, you may want to consider a Medigap policy.

The only consequence I can think of if you were to quit going to physical therapy is you won't get better.

Due to the specificity of your question, we suggest you call one of our independent licensed insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Ginger on January 11, 2016

MY husband had a stroke last year and has received outpatient PHYSICAL, SPEECH AND OT Therapy 3 times a weeks since July. We had to go on medicare this year. Can you tell me does the plan F cover above the medicare gap or do they just pay the deductible and co-pay?

Ginger,
Plan F only fills in the gaps of Original Medicare for Speech, Physical, and Occupational Therapy. We know it can feel discouraging because their is a cap in coverage for these treatments, but if deemed medically necessary Medicare can continue coverage. Hope thi helps.
-Amy from https://www.senior65.com/


By jack hollister on December 27, 2015

What medicare supplemental insurance plan does not have a copay for physical therapy?

Jack,
Here is a chart of Medicare Supplement plans, so that you can compare which ones cover your Part B copays and coinsurance.
-Chris from https://www.senior65.com/


By Gladys Cobb on December 27, 2015

Will any Medical plan pay for 'in-water physical therapy'? - without a high co-pay. My Neurologist recommends in-water therapy, however at a $45. Co-pay I cannot afford it. I am in pain everyday.

Gladys,
Thank you for your question. Original Medicare will always have coinsurance or a copay for physical therapy until you reach their cap. Now, if you were to enroll in a Medicare Supplement plan that covers your Part B coinsurance and copays, you should be covered, with no out of pocket costs, for physical water therapy, as long as it is approved by Original Medicare.
-Eric from https://www.senior65.com/


By David Stiles on December 21, 2015

I have Medicare Original and supplemental B coverage. If my primary doctor refers me to a physical therapist for exercise therapy for pulled muscles/ligaments in my lower back, would Medicare approve this automatically, and would they pay 80% of the cost up to a certain point?

David,
You will want to check with CMS to see if that would be approved, as Medicare deems what is allowable for physical therapy. If they did approve you, they would pay 80% after you meet your deductible, and up to the physical therapy cap.
-Jacima from https://www.senior65.com/


By Cathy Rich on July 16, 2015

I have a degenerative disc on the right side of my back. What do you think is better: physical therapy, chiropractic, or acupuncture? And, which one will Medicare cover the most costs of?

Cathy,
Thank you for your question. Medicare covers medically necessary chiropractic spinal manipulations, it covers physical therapy (to a cap), and it does NOT cover acupuncture. We suggest speaking with your primary doctor about which treatment is best for you.
-Amy from https://www.senior65.com/


By Trent on July 09, 2015

How much will I pay with Medicare Advantage for physical therapy? I know you say it varies but can you give me an idea..

Trent,
Great question. Unfortunately, we don't have a great answer. Since Medicare Advantage are not standardized, each plan can choose to cover your medical services differently. If you call us at 800-930-7956, we'd be happy to help you find quotes for Medicare Advantage costs for physical therapy services.
-Eric from https://www.senior65.com/


By William king on June 30, 2015

How much will I pay for physical therapy since I have Medigap N? Only at cap. I don't think I meet the extended care.

William,
Good question. If you do not exceed the initial Medicare physical therapy cap, Medigap Plan N requires you to pay your Part B deductible, but you shouldn't have any other out of pocket costs. Hope this helps.
-Eric from https://www.senior65.com/



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