Medicare insurance coverage is something a lot of Americans depend on in order to receive the treatments they need. Until recently, however, many Medicare recipients were avoiding medically necessary treatments simply because they were afraid Medicare wouldn’t cover the cost, and they couldn’t afford to pay out of pocket.
Recent changes to Medicare coverage for physical therapy have ended the physical therapy cap, a long-standing limitation on how many physical therapy visits per year Medicare would cover. Because of this cap, patients were avoiding or skipping visits they desperately needed. Fortunately, the recent changes to Medicare are sure to benefit recipients who need physical therapy.
What This Means for You
Now that the proper legislation has been passed, and the proper budget’s in place, Medicare recipients are free to pursue medically necessary physical, occupational, and speech/language therapy without fear that some of the visits won’t be covered. There are, however, a few caveats that recipients need to be aware of.
First of all, the new legislation applies to original Medicare specifically. Medicare Advantage Plans (like a PPO or an HMO) operate under different rules, so if that’s what you have you’ll want to check your plan to see how coverage works for you before starting your visits.
Secondly, this information only applies to “medically necessary” treatments. Suggested treatments that aren’t medically necessary won’t be covered.
More Physical Therapy Visits Per Year
Another thing lifting the physical therapy cap means to you is that you don’t need to worry about avoiding therapy early in the year, or taking only a few visits when you need several, for fear that you won’t have any available later in the year.
For example, suppose you develop chronic pain in January or February, and your physical therapist or doctor finds physical therapy medically necessary. With the therapy cap gone you don’t have to worry that if you take a lot of visits now you won’t have any available later in the year if you have a fall, stroke, or knee surgery, and critically need physical therapy.
With the cap gone you won’t max out your therapy visits early in the year, and then be left to pay everything out of pocket should dire situations occur later in the year.
Similarly, a patient with episodic, chronic pain does not need to “ration” their visits to last throughout the year. They are free to address flare-ups more effectively with treatments 2 to 3 times a week versus once or twice a month. With the cap gone, if you need more frequent visits to get pain under control quickly, you’re covered. You’ll just pay your regular co-pay or co-insurance.
Remember, your physical therapy needs to be medically necessary, which is determined by your therapist and/or your doctor. Beyond that, you’re finally free to pursue treatment until it’s actually complete. So if you’re ready to get the help that you need, contact Clear Choice Physical Therapy to find out who we are, what we treat, and how we can help you today.
