Medicare covers physical therapy when it's medically necessary. Here's how the coverage and costs work.
How does Medicare cover physical therapy?
Medicare Part B covers outpatient physical therapy that's medically necessary to treat your condition, prescribed by your doctor, and provided by a Medicare-approved therapist or facility. This includes therapy to recover from surgery, injury, stroke, or to manage chronic conditions. You typically pay 20% of the Medicare-approved amount after meeting your Part B deductible. Medicare also covers physical therapy during a covered inpatient hospital or skilled nursing facility stay under Part A. The former annual therapy dollar cap has been eliminated, but once your therapy costs pass a yearly threshold, your provider must confirm the care remains medically necessary. Call 1-800-MEDIGAP at 1-800-633-4427 for help.
What you'll pay and how to lower it
Under Original Medicare you pay 20% of the Medicare-approved amount for outpatient physical therapy after your Part B deductible, and there's no out-of-pocket maximum with Original Medicare alone. Over many sessions, that 20% can add up. A Medigap (Medicare Supplement) plan can pay some or all of that coinsurance, making ongoing therapy far more affordable and predictable. Medicare Advantage plans also cover physical therapy, typically with set copays per visit and network requirements. The best option depends on how much therapy you expect and your budget. Call 1-800-MEDIGAP for a free comparison of plans that lower your therapy costs.