Does Medicare Cover Therapy Services?
As we age, new experiences and challenges await us. Some are incredible – like the birth of new grandchildren or the peace of retirement – and some aren’t so incredible – like recovering from a major fall or going through the death of a loved one.
Mental and physical therapy services are meant to get your mind and body back in shape, and after 65, you’ll likely be relying on Medicare to help insure those services.
Obtaining therapy services can be expensive, so understanding what Medicare will and will not cover can help bring a peace of mind that will ease your worry.
Therapy Services You May Need
Entering into your “Golden Years” can bring about challenges you may not be equipped to handle on your own.
Maybe the move into this phase of life is exciting and eagerly anticipated; the thought of retirement and grandchildren is exactly what you have been waiting and planning for, for years. Meeting challenges head on and fighting for the ability to remain independent and healthy motivates you.
However, the challenges that aging brings, mentally and physically, could cause you stress and uneasiness. Learning to deal with transitioning from work to retirement, age-related medical conditions, finding meaningful activities with physical or mental limitations, and coping with mortality as those you know and love begin to pass on, can seem to be too much to handle.
Whether you are approaching old age with open arms or uncertainty, getting help may be necessary when dealing with aging.
Some common services and therapies you might need include:
- Mental health services and therapy: help with conditions like depression and anxiety
- Occupational therapy: help to develop, recover, or maintain skills that are necessary for daily life
- Physical therapy: help to relieve pain and restore physical functions such as flexibility, strength, balance, and coordination
- Therapy dogs and service animals: lend support on an emotional, physical, or therapeutic level
Being able to obtain and afford the needed services to make this time of your life more manageable is definitely a concern. Original Medicare, Medicare Supplements, and Medicare Advantage plans may cover some of the therapy services you might need as a senior. Let’s take a look and see what will and won’t be covered.
Does Medicare Cover Mental Health Services and Therapy?
For many types of mental health services and therapies, Medicare Part B (medical insurance) will help cover the costs.
Mental health services are used to treat conditions such as anxiety and depression, and they’re often referred to as counseling and therapy.
Outpatient Mental Health Services and Therapy
According to Medicare.gov, Medicare Part B covers mental health services and visits with the following if they accept Medicare assignment:
- Psychiatrists or other doctors
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physicians assistants
Medicare Part B will only help cover these therapy services if the sessions take place in an outpatient (outside of the hospital) setting. Examples of outpatient settings include:
- A doctor’s or health care provider’s office
- Hospital outpatient department
- Community mental health center
Medicare Part B will also help pay for the following outpatient mental health services:
- One depression screening per year – no cost to you if your doctor accepts Medicare
- Individual or group psychotherapy
- Family counseling (to help with your treatment)
- Testing to confirm that the services are helping
- Psychiatric evaluation
- Medication management
- Prescription drugs that aren’t self-administered
- Diagnostic testing
- Partial hospitalization
- A one-time “Welcome to Medicare” preventive visit
- A yearly “Wellness” visit
- Treatment for inappropriate use of drug and alcohol use
What will outpatient mental health therapy cost you?
The Centers for Medicare and Medicaid Services (CMS) states that there are no longer limits on how much Medicare pays for your medically necessary outpatient therapy services in a calendar year. The kicker here is that your therapy must be considered reasonable and necessary for Medicare to cover the service.
So, as long as your therapy is medically necessary, you will pay 20% of the cost for diagnosis and treatment after your Medicare Part B deductible. Medicare will pay the remaining 80%.
If your doctor or health care provider recommends you receive services more often than Medicare covers, you may have to pay some or all of the cost.
We recommend considering a Medicare Supplement which would cover the 20% coinsurance, but we’ll cover that in more detail later in this article.
Inpatient Mental Health Services and Therapy
In the case of a more severe mental health issue, you could receive inpatient care. This consists of one or more nights stay in the psychiatric hospital or psychiatric unit of a general hospital.
This type of treatment is administered if you need around-the-clock care, and typically lasts no longer than 30 days.
What will inpatient mental health treatment cost you?
Medicare Part A covers inpatient general hospital and psychiatric hospital services, but it will only cover 190 days of treatment in a psychiatric hospital in your lifetime.
This cap does not apply to regular hospital stays. Medicare Part B will cover your physician while you are admitted to a general or psychiatric hospital as an inpatient for mental health services.
Does Medicare Cover Occupational Therapy?
When day-to-day life gets hard, an occupational therapist may be able to help. Sometimes old age can bring about problems such as arthritis, chronic pain, and debilitating health problems like strokes, heart attacks, and broken bones.
These problems can lead to difficulty in performing everyday tasks essential to living a productive life.
Outpatient Occupational Therapy
Occupational therapists can help you overcome these challenges through exercises, rehabilitation techniques, education, and the use of supportive equipment. Daily tasks that might once have been challenging such as bathing, dressing, and feeding yourself can become doable again with this type of therapy.
Outpatient occupational therapy is usually administered in a facility set up for the services. This means making and keeping appointments, which is a big obstacle for this type of therapy.
Consistency and commitment are key for improvement, and when appointments are missed because of family obligations, car trouble, or whatever reason, progress is stalled.
Medicare Part B helps pay for medically necessary outpatient occupational therapy services, with no monetary limit per year.
What will outpatient occupational therapy cost you?
After your deductible, you will pay 20% of the Medicare-approved amount for occupational therapy services and Medicare will pay the remaining 80%.
Inpatient Occupational Therapy
Medicare.gov lists inpatient occupational therapy as medically necessary care you receive in an inpatient rehabilitation facility or unit, and it can be helpful if you’re recovering from a serious injury or illness.
Medicare Part A covers this service if your doctor certifies that you have a medical condition that requires intensive rehabilitation, continued medical supervision, or coordinated care that requires your doctors and therapists working together.
Medicare will help cover:
- Rehabilitation services
- A semi-private room
- Meals
- Nursing services
- Drugs
- Other hospital services and supplies
Medicare will not cover:
- Private duty nursing
- A phone or television in your room
- Personal items
- A private room, unless medically necessary
Medicare Part B will cover the doctors’ services you receive while in an inpatient rehabilitation facility.
What will inpatient occupational therapy cost you?
With Medicare Part A, you will pay the following for each benefit period (a benefit period begins the day you’re admitted as an inpatient and ends when you haven’t received any inpatient care for 60 days in a row):
- Days 1-60: $1,364 deductible
- Days 61-90: $341 coinsurance each day
- Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Each day after the lifetime reserve days: all costs
Does Medicare Cover Physical Therapy?
The goal of physical therapy for seniors is to make daily tasks and activities easier, allowing them to be as independent as possible.
According to Senior Living, physical therapy combines stretching, walking, massage, hydrotherapy, and electrical stimulation to relieve pain and restore fitness such as flexibility, strength, balance, and coordination.
Outpatient Physical Therapy
Physical therapists can help you regain strength and use of your limbs, relieve pain, and improve your overall fitness.
Physical therapy can help with things like:
- Stroke
- Alzheimer’s Disease
- Parkenson’s Disease
- Osteoarthritis
- Recovery from broken bones
- Knee, back, shoulder, and hip pain
- Incontinence
- Diabetes
Outpatient physical therapy in typically done in a facility that is set up to administer adequate services. As with occupational therapy, attending appointments on a regular basis is important to the overall effectiveness of the therapy.
What will outpatient physical therapy cost you?
Medicare Part B helps pay for medically necessary outpatient physical therapy services, with no monetary limit per year.
After your deductible, you will pay 20% of the Medicare-approved amount for physical therapy services and Medicare will pay the remaining 80%.
Inpatient Physical Therapy
Inpatient physical therapy and inpatient occupational therapy fall under the same guidelines, according to Medicare.gov. Inpatient physical therapy is any medically necessary care you receive while in an inpatient rehabilitation facility or unit.
In order for Medicare Part A to cover inpatient physical therapy, your doctor must certify that you have a medical condition that requires intensive rehabilitation, continued medical supervision, and that coordinated care between your doctors and therapists is necessary.
Medicare Part B will help cover the cost of your doctors’ services while you are in an inpatient rehabilitation facility.
What will inpatient physical therapy cost you?
With Medicare Part A, you will pay the following for each benefit period (a benefit period begins the day you’re admitted as an inpatient and ends when you haven’t received any inpatient care for 60 days in a row):
- Days 1-60: $1,364 deductible
- Days 61-90: $341 coinsurance each day
- Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Each day after the lifetime reserve days: all costs
Does Medicare Cover Therapy Dogs and Service Animals?
It isn’t unusual to see a person in public with a service animal or therapy dog these days.
In fact, the use of service dogs has increased tremendously in the past decade. Share America tells us that in the United States, there are approximately 500,000 service dogs, making it possible for people with disabilities to live independently and overcome the challenges of daily life.
The American Disabilities Act (ADA) states that:
- Dogs are the only recognized service animals under title II and II of the ADA
- Service dogs are individually trained to do work or perform tasks for persons with disabilities
- Generally, title II and title III entities must permit service animals to accompany people with disabilities in all areas where members of the public are allowed to go
Dogs trained as service animals provide a service for an individual such as leading a blind person, pulling a wheelchair, alerting a deaf person, alerting and protecting a person having a seizure, alerting a diabetic of low blood sugar, calming a person with Post Traumatic Stress Syndrome (PTSD), along with many other duties.
The ADA isn’t the only Act that defines what a service animal is and does. The Fair Housing Act and Air Carrier Access Act, along with some state and local laws, have broader definitions of service and assistance animals than the ADA. Under these definitions, service animals can provide emotional and therapeutic support as well as physical support.
Whether you are looking at the limited definition of therapy dogs and service animals or the more broad definition, they aren’t going to be covered by Medicare.
While Medicare meets many of your healthcare needs, it will not cover the cost of a service animal. Disability Benefits Help states that not only does Medicare not cover this cost, but no health insurance – even private companies – will cover service animal expenses.
However, there are other ways to get a service dog or assistance animal. Many non-profit organizations raise, train, and offer service animals to the disabled – often free of charge or for a reduced rate.
A few organizations to check out are:
- Guide Dog Foundation For the Blind
- Canine Companions for Independence (CCI)
- International Association of Assistance Dog Partners (IAADP)
Do Medicare Supplements Pay for Therapy?
If you choose to purchase a Medicare Supplement, which we highly recommend to all Medicare enrollees, your costs will be minimal for therapy services.
All Medicare-approved therapy services, such as mental health therapy and physical therapy, will be covered by your Medicare Supplement.
By law, your Medicare Supplement must cover what Medicare covers, so if Medicare approves the charge, your Medicare Supplement will, too.
Depending on which Medicare Supplement plan you choose, you may have zero out-of-pocket cost, or a small deductible for outpatient services. Under most Medicare Supplement plans that we recommend, you wouldn’t pay anything for inpatient therapy services.
However, since Medicare Supplements exist to supplement Medicare, they will not cover any therapy services that Medicare doesn’t cover. For example, Medicare Supplements will not cover a therapy dog or service animal, because Medicare doesn’t cover it.
Learn more about Medicare Supplements and which plan is right for you by reading these articles:
Do Medicare Advantage Plans Pay for Therapy?
Medicare Advantage plans are private plans offered by insurance carriers. While they are separate from Original Medicare, they are still required to offer at least the same amount of coverage as Medicare.
This means that if a therapy service is covered by Medicare, your Medicare Advantage plan is required to cover it, too.
[Related: Medicare Advantage vs. Medicare Supplements: How Do You Choose?]
Medicare Advantage plans are allowed to go above and beyond and cover things that Medicare doesn’t. For example, almost all Medicare Advantage plans today offer some form of vision and dental coverage, free gym memberships through SilverSneakers, and even an allowance for over the counter drugs and items.
While Medicare Advantage plans are starting to offer more and more in extra benefits, from covering the cost of meal deliveries and even home cleaning services if it helps patients manage their health better, we haven’t seen anything about therapy services yet.
Hopefully, in the future, Medicare Advantage plans will start offering extra coverages and benefits like service animals and therapy dogs, but as of today, that’s not yet the case.
To make sure your Medicare Advantage plan covers your needed therapy services, contact your insurance agent or get in touch with your plan.
If you purchased your Medicare Advantage plan through us here at Medicare Allies, simply call us any timeand we can help confirm your benefits!
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