Does AARP United HealthCare cover physical therapy

Out-of-pocket Medicare costs for physical therapy can add up quickly. Fortunately, Medicare Supplement insurance plans generally pay your share of covered expenses. If you have a stroke, injury, joint replacement, or other debilitating condition, your doctor may prescribe Medicare physical therapy to help you recover. To be covered, your treatment must be performed by a licensed physical therapist who accepts Medicare. You can get treatment in the hospital, in a skilled nursing facility, outpatient clinic, or even in your home. Here’s what you need to know about your Medicare coverage for physical therapy services.

What are Medicare physical therapy services?

According to the Alliance for Physical Therapy Quality and Innovation (APTQI), physical therapy helps people with injury, chronic pain, and people who have problems moving. Physical therapy can:

• Improve balance
• Decrease the risk of falls
• Help people live independently
• Improve mobility
• Help manage arthritis and joint pain
• Improve cardiovascular function and manage chronic diseases such as diabetes and heart disease
• Reduce the need for opioid pain medication

The APTQI reports that physical therapy may also lower Medicare spending under Part A and Part B. For patients who had surgery, Medicare spending was 75% lower than total average spending for those who received Medicare physical therapy services during recovery.

Do Medicare Supplement insurance plans cover physical therapy?

Medicare Supplement (Medigap) insurance plans are designed to help pay your out-of-pocket costs under Part A and Part B. Plans sold today do not pay any costs associated with Medicare Part D prescription drug plans, and they can’t be combined with a Medicare Advantage plan.

Medicare Supplement insurance plans are sold by private insurance companies. Medicare Supplement basic benefits are standardized and set by the federal government. In most states, there are standardized plans with lettered names, such as Medicare Supplement Plan G. What this means is that Medicare Supplement Plan G sold by one insurance company has essentially the same benefits as Plan G sold by another company. Three states (Massachusetts, Minnesota, and Wisconsin) have their own standard plans.

Medicare physical therapy services are generally covered by Medicare Part B. The cost sharing for most Part B services is “80/20.” That is, usually Medicare pays 80% and you pay a 20% coinsurance. Most Medicare Supplement insurance plans cover all of your Part B coinsurance, although some plans generally pay part of your Part B coinsurance.

Generally speaking, if Medicare covers a service, your Medicare Supplement plan must also cover at least part of it. For most medical services, if Medicare denies the claim, your Medigap plan will also deny it. Most providers automatically bill your Medicare Supplement insurance plan once Medicare pays its share.

NEW TO MEDICARE?

Do Medicare Supplement insurance plans ever deny physical therapy coverage?

In the past, you were limited to a certain number of Medicare physical therapy services each year. If you exceeded the annual limit, usually neither Medicare nor your Medicare Supplement plan would cover the charges. Now, however, Medicare removed the cap on physical therapy, so you can continue to get treatment as long as your doctor believes it is medically necessary.

If you have Medicare Supplement Plan C or Plan F, you have “first-dollar” coverage for Medicare physical therapy services. These plans cover the Part B deductible, so they pay the first time you get coverage. With most other Medicare Supplement insurance plans, you have to pay your Part B deductible before your plan kicks in.

However, Medicare Supplement Plans C and F are not available to those eligible for Medicare on January 1, 2020 or later.

Only expenses covered by Medicare Part B count toward your deductible. If you spend $226—the Part B deductible in 2023—on an eye exam and glasses, for example, those expenses won’t satisfy your deductible because Medicare doesn’t cover routine eye care.

Two Medicare Supplement plans, Plan F and Plan G, may pay your Medicare Part B excess charges. If you see a doctor who’s legally allowed to charge more than the Medicare-approved amount, the difference is called the excess charge. If your plan doesn’t cover Part B excess charges and you see a physical therapist who doesn’t accept Medicare assignment, you may be charged 15% more than Medicare’s allowable charge. If that happens to you, your Medigap plan won’t pay that 15% upcharge, unless you have Plan F or Plan G.

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