Medigap: Physical Therapy Coverage Explained

Learn how Medigap covers physical therapy

by Katie Banks+ on Feb 11, 2018 | 3 Comments

Does Medigap cover physical therapy after an injury?  Rather than wait until an emergency happens, we have detailed below how Medigap covers physical therapy.Note: This article was updated on 2-11-2018 to reflect new information on physical therapy caps.

 

Medicare’s Physical Therapy Coverage

Until Feb 9, 2018, Original Medicare had a combined cap on physical and speech therapy each year of $2,010. The US Senate recently voted for language that permanently repeals Medicare’s maximum payout caps. The best news is that the new change is effective for all claims back to January 1, 2018. Those with Original Medicare without Medigap will still be required to pay the part B deductible, 20% of the office visits and 100% of any excess charges.

What Medigap Pays for Physical Therapy

If you seek physical therapy, the majority of Medigap plans will cover 100% of your copays and coinsurance*; however, only Medigap Plan C and F covers both your Part B deductible.  Additionally plan F and G cover your Part B excess charges.

Learn More about Medigap Get a Medigap Quote

*Plans K and L make you pay 50% and 75% of these costs, respectively. Plan N requires you to pay a $20 copay per doctor’s office visit.

For help finding a Medigap plan in your area call one of our licensed independent insurance agents at 800-930-7956.

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Reader Comments and Questions

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By Jean on October 27, 2017

With plan N would someone receiving physical therapy after surgery such as knee or hip replacement or wrist brake have to pay the $20.00 copayment at every visit, are physical therapy visits considered an office visit?

Jean
It depends how it is coded by your physical therapy location. Often times PT is not considered an office visit and would not require a N copay. Check out our Plan N details page to learn more.
-Jacima from Senior65


By Louise May on August 30, 2016

I hurt my back a few months ago doing yoga and physical therapy isn't really working. I've heard chiropractic is hte way to go. Does Medicare cover that? Also, I'm turning 65 in two months, which plan will cover the most of my out of pocket costs. I don't care what monthly cost is (well I do, but I'd rather spend 300 a month than have unforeseen costs).

Louise May,
Medicare does cover chiropractic. While there is not a cap on chiropractic coverage, Medicare only pays for manipulation of the spine for a subluxation.

As for your second question, we suggest you look into Medigap plans in your area -as they can cover all of your Medicare out of pocket costs (you can other costs if Medicare doesn't cover it). You can get a Medigap quote here, or call to speak to one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Geoff on June 09, 2016

My son had a stroke on May 7th. He is only 25, but he is enrolled in Medicare because he's disabled. He needs speech and physical therapy, but that cap is really low. Will I have to pay everything else out of pocket?

Geoff,
You just have to have your son's doctor recommend further physical and speech therapy. At that time, Medicare will review, and determine if the cap will be increased. Hopefully, it will be and you can save some money. Best of luck!
-Chris from https://www.senior65.com/



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