Whether it’s because of an illness or an injury, at some point in our lives, many of us will need therapy to regain or maintain our ability to function. Medicare covers inpatient physical, speech and occupational therapy as well as all the outpatient therapy that people need.
Medicare offers several outpatient therapy options. You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, 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 outpatient therapy services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.
For 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 you need ongoing therapy, your doctor must review it and recertify your need.
Medicare now covers as much outpatient physical, speech and occupational therapy as people need. In February, Congress lifted the cap on outpatient therapy services retroactive to January 1, 2018. (In 2017, Medicare generally only covered up to $1,980 of outpatient speech and physical therapy and the cap in 2018 was originally $2,010. Only if your doctor made the case that additional therapy was medically necessary to regain or maintain function, Medicare sometimes would cover additional services.)
Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental coverage, such as Medicare supplemental insurance or “Medigap,” retiree coverage or Medicaid, should pay the rest.
Medicare offers inpatient physical, speech and occupational therapy in a nursing home as well as in a Medicare-certified rehabilitation hospital, but coverage is quite limited. If you want inpatient care in a nursing home, you will need to have been hospitalized as an inpatient for at least three days in the 30 days prior to admission. (Note: You can spend three nights at a hospital and the hospital may still deem it an outpatient stay.) If you simply need rehabilitation services–be it nursing, therapy, social worker help or psychological services–Medicare will cover care in a rehabilitation hospital under its hospital benefit.
Medicare also covers cardiac rehabilitation care. Click here to read more about this coverage.
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