Does Insurance Cover Physical Therapy?
Updated: Apr 25
Almost every day, our patients are asking us — does insurance cover physical therapy?
This is a question that needs a closer look as there isn't one straightforward answer.
Physical therapy (PT) is imperative for various rehabilitation and recovery programs. It sometimes is necessary to help you recover from an injury, post-surgery, or help treat an existing condition.
One or two sessions will not suffice to achieve long-lasting results, so insurance coverage becomes vital when paying the fees and other expenses. No one should get in debt to recover from a health problem, as it should be a priority for any human being.
Let's explore the subject of PT insurance in detail.
Physical therapy health insurance coverage
So is physical therapy covered by insurance?
First, the good news - most insurance companies and their plans, whether governmental or private, cover medically necessary physical therapy services.
Physical therapy qualifies as an essential health benefit among other rehabilitation services under the Affordable Care Act. As HealthCare.gov explains, it's the health care services that meet medical standards and are needed to diagnose or treat an illness, injury, condition, or disease.
Usually, if the insurance company covers the PT insurance, it is around 50-75 percent of the cost. Don't forget that some insurers may ask their clients to provide a doctor's referral or care plan before they do so.
Most common health insurance for physical therapy
There are three most common types of physical therapy coverage that most insurers provide. Let's look at each one of them.
Deductible and coinsurance The deductible is the amount the patient pays out of pocket before the insurance covers any costs. After the deductible is met, the insurance begins to pay some of the costs. However, the patient still needs to cover a chunk, which is called coinsurance. Coinsurance is the percentage of the visit the client needs to pay after meeting their deductible. This percentage is determined by each company differently and individually.
Only co-pay The simplest option when the patient pays a flat fee determined by the insurer for each visit.
Deductible and co-pay The third option is when the patient meets the deductible and then co-pays for every visit.
Medicare coverage for physical therapy
Medicare is an insurance program covering people aged 65 years or older and younger people with disabilities and certain other conditions. It is provided by the federal government.
Medicare for physical therapy generally covers around $30 for each procedure and about & $100 for a PT session.
Medicare and physical therapy can get confusing, so here are the different Medicare plans and how each of them relates to PT coverage.
Medicare Part A It's also called hospital insurance and will cover the patient's treatment during his stay at rehabilitation or a nursing facility. It can also reimburse some home health care that a doctor deems medically necessary after a hospitalization.
Medicare Part B Covers essential outpatient services such as medically necessary physical therapy for patients. It includes diagnosing and treating chronic diseases and conditions that may require therapy and some preventative care.
Physical therapy Medicare cap for parts A and B is a total of $2,050.
Medicare Part C It is the insurance provided by private companies. It includes coverage offered in Medicare parts A & B and other services, including PT when medically necessary.
Medicare Part D Doesn't cover physical therapy treatments but pays for medications that are part of the recovery plan.
Medigap This is a supplemental insurance plan sold by private insurers. It doesn't cover PT but pays for any associated out-of-pocket costs such as co-pays, coinsurance, deductibles, and medical expenses outside the U.S.
Physical therapy cost without insurance
According to Theervo.com, the average physical therapy cost can range from $20 to $350 per session, with most paying $30 with insurance and $125 per session is the average physical therapy cost without insurance.
The PT fees include the initial consult and the use of any special equipment. The final cost will depend on the type of injury and treatment and the number of sessions received.
Are there some services that physical therapists provide that are not covered by insurance?
It's important to know that certain services will not be covered by insurance. These are usually various wellness, fitness programs, health education, prevention, and sports performance enhancements.
Most insurance plans will also cover only a limited number of physical therapy visits, and usually, it's 20 visits.
Check with your insurer to find out about your plan.
What if you don't have insurance?
Those who don't have health insurance covering physical therapy services will need to pay the provider directly.
To reduce the costs, the patient can ask for a modified program, fewer sessions, or discuss a special payment plan.
Do I have physical therapy coverage?
Most insurance plans cover physical therapy, but it's best to check with the provider to have the definitive answer.
And if you're looking for an insurance policy at the moment, make sure you check that in advance.
How to choose health insurance?
First of all, if the employer provides your health insurance, you will need to choose from their list.
If you're getting it on your own, you have more options. In any case, it's crucial to do your research as often a plan with a lower monthly premium comes with higher out of pocket costs.
Here are some questions you should ask:
Does insurance cover physical therapy?
Is my provider in-network or out-of-network?
Do I need to get a referral from my doctor before starting PT?
How many PT visits can I get covered?
Does my plan pay for PT in an inpatient or outpatient setting?
Does my current plan have any limits or exclusions for PT?
How much will I need to pay out-of-pocket?
Most insurance plans cover physical therapy. However, there are many variables to consider, such as deductibles, co-pays, coverage limits, and specific requirements to qualify.
So the best insurance for physical therapy is the one that works best for your circumstances and financial situation. Make sure you do your research and ask all the questions before you choose your insurance provider.
Physical Therapy in Miracle Rehabilitation and Physical Therapy Center
Miracle Physical Therapy and Massage Center Inc. provides physical therapy and massage therapy for diverse diagnoses.
Our physical therapists understand how important it is to maintain an active lifestyle and provides therapy plans and implementation for most medical situations, including sports injuries, traumas after car accidents, strokes, or other debilitating injuries.
Whether you've been injured on the field, are recovering from surgery, or simply twisted your back while gardening, we are dedicated to getting you back in the game of life. Let your insurance cover physical therapy and let's get you back on the right path.
Get in touch with Miracle Rehab to talk about your financial situation and whether you have health insurance or not. We will make sure to find the best outcome possible for you.