Medicare Your Coverage Options

Medicare covers physical, speech and occupational therapy

Written by Diane Archer

Whether it’s because of an illness, an injury or another reason, many of us will need therapy to regain or maintain our ability to function at some point in our lives. Medicare covers outpatient physical, speech and occupational therapy as well as inpatient therapy services.

You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, or public health agency or from a private therapist, so long as the provider is Medicare-certified and you qualify for coverage. You can also receive these services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.

For Medicare Medicare to cover outpatient therapy, you must meet the eligibility criteria:

  • Therapy must be a safe and effective treatment for you.
  • A therapist must deliver the services or direct the delivery of the services.
  • Your doctor must certify you need the therapy to regain or maintain your ability to function and set up a plan of care for you in advance of your receiving services. And, if it is ongoing, your doctor must review it and recertify your need.

Medicare will cover up to $1,960 of speech and physical therapy in 2016 and $1,980 in 2017.  It will also cover an additional $1,960 of occupational therapy in 2016 and $1,980 in 2017.  And, if your doctor makes the case that additional therapy is medically necessary to regain or maintain function, Medicare sometimes will cover additional services. Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental insurance should pay the rest, if you have it.

Medicare also covers cardiac rehabilitation care.  Click here to read more about this coverage.

Click here to learn about Medicare coverage of inpatient therapy in a nursing home.

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