The aging process involves physical and cognitive changes that affect how individuals carry out physical activities, but physical therapy helps cope with these changes. Insurance plans like Medicare can offset the cost of physical therapy. Under certain circumstances, seniors with Medicare may benefit from physical therapy with no out-of-pocket costs.

This article discusses physical therapy for seniors with Medicare. Read on to find out if Medicare covers your treatment.

What is Physical Therapy?

Physical therapy treats health problems related to the movement and physical functioning of the body. Contrary to popular belief, physical therapy is not only concerned with physical rehabilitation after injury or surgery; it can also successfully treat patients with a variety of issues, from women in postpartum to seniors with reduced mobility. 

Physical therapists begin treatment by assessing the patient’s posture, muscle imbalances, mobility, strength, and flexibility, then continue with a personalized treatment plan consisting of manual therapy, therapeutic exercises, neuromuscular reeducation, and others. These treatments are proven to help patients gain greater mobility, coordination, and flexibility to reduce pain and achieve a better quality of life.

Importance of Physical Therapy in Seniors

Aging is a normal process involving physical and cognitive changes that can affect how a person carries out their daily tasks. The most important goal for older persons is to maintain independence and move with freedom for the longest possible. Physical therapy is essential in helping seniors achieve this.

Physical therapy for seniors has the following benefits: 

  • Reducing the need for pain medications
  • Quicker recovery from injury
  • Improving mobility and movement
  • Preventing falls
  • Improving quality of life

There are also potential risks to seniors missing physical therapy treatment, including:

Increase in Falls: Falls are common in old age, causing injuries and reduced activity levels. The risk of falls is even higher after a hospital stay. Missing physical therapy after such an event can lead to further injuries and re-hospitalization.

Increased Pain: Reduced mobility leads to pain. If you stop moving to avoid pain and don’t undergo physical therapy, your joints will inevitably stiffen. 

Reduced Endurance: Missing physical therapy after hospitalization can negatively influence your long-term strength and endurance, leading to increased heart rate and blood pressure, and decreased oxygen saturation levels, making you vulnerable to stroke, blood clots, and heart attacks.

Missing Out on Education: Seniors benefit from education through physical therapy as they learn how to complete their daily tasks more efficiently. Lacking the necessary information may negatively affect physical and mental well-being and quality of life.

Does Medicare Cover Physical Therapy? How Much is Covered?

Medicare physical therapy for seniors is covered if your doctor deems it medically necessary. The exact amount covered depends on your situation.

Medicare Part A pays some or all physical therapy costs you receive at:

  • An inpatient rehabilitation facility
  • A skilled nursing facility (or at home after hospitalization of at least three days)

Prerequisites:

  • You must be enrolled in Part A
  • You must have remaining days in your benefit period 
  • You have a qualifying hospital stay 
  • Your doctor assessed that you need daily skilled care 
  • The facility is Medicare-approved

The costs of Medicare physical therapy for seniors in Part A will depend on several factors, including the location and duration of the treatment and the number of days left in your benefit period.

Medicare Part B may pay for outpatient physical therapy in the following locations:

  • At a doctor’s or therapist’s office
  • At outpatient rehabilitation facilities
  • In hospital outpatient departments
  • At skilled nursing facilities (if receiving treatment as an outpatient)
  • At home, if a Medicare-certified home health agency is providing it and Part A does not cover it

Medicare Part B covers physical therapy even without prior hospitalization. You only pay 20 percent of the Medicare-approved amount, but you must pay the monthly Part B deductible to be eligible. To further reduce out-of-pocket expenses, it helps to have Medicare Advantage (Part C) and Medigap plans in place.

There is no limit to physical therapy coverage of medically necessary outpatient services in a calendar year. But remember that physical therapy is only covered if ordered by a doctor. If this isn’t the case, your therapist must give you an Advance Beneficiary Notice of Noncoverage (ABN), a written notice confirming that Medicare will not cover your treatment. Your doctor may also recommend services other than Medicare physical therapy for seniors. If this happens, you may have to pay for them.

So does Medicare cover physical therapy entirely? Yes, under certain conditions. To better understand the costs of your treatment and your options to offset them, consult your doctor or a physical therapist about Medicare physical therapy.

How Much Does Physical Therapy Cost Without Insurance?

Physical therapy sessions can range from $150 to $250 per session if you don’t have access to Medicare physical therapy.

Depending on the type of treatment (like physical therapy for the knee or back), expect to be billed by the hour, as an appointment typically lasts 30-120 minutes. Additionally, you will pay for the initial assessment and any special equipment. The length of treatment and number of sessions also affect the total cost you pay.

Chaux Physical Therapy is Here to Help

Physical therapy helps seniors improve their quality of life, whether they are struggling with injury, a long-term illness, or want to improve their general mobility. Seniors with Medicare have physical therapy covered if it’s deemed medically necessary. So if you are in pain and missing physical therapy because of the costs, visit your doctor to understand whether your treatment is covered. 

Dr. Alexandra Chaux is a physical therapist providing Medicare physical therapy for seniors. In addition to manual therapy, physical therapy exercises, and neuromuscular re-education, Dr. Chaux also offers patient education and fall prevention tips to help seniors achieve better mobility in their lives.

If you’re interested in Medicare physical therapy, contact Chaux Physical Therapy at 805-203-9940 and learn more on how physical therapy can help you move with confidence as you age.