Physical Therapy and Medicare
explained by Dr. Rhonda Cowern, DPT, CertDN
There has been lots of talk on Capitol Hill about Medicare insurance coverage and changes for all Medicare beneficiaries, including changes in physical therapy coverage. Medicare changes coverage limitations annually and you may have noticed your deductible has gone up over the years. A deductible is the portion of your insurance contract that you must pay out of pocket before your insurance benefits “kick in.” On a side note, many patients have a supplemental insurance, mainly to cover their out-of-pocket costs. Not all supplement insurances cover the deductible. For 2018 the Medicare deductible is $183 dollars. If you have already met the deductible and your doctor writes you a prescription for physical therapy here’s how it works.
What now? What will it cost? Medicare is willing to cover 80% of all medically necessary physical therapy fees. You are responsible for the remaining 20%. Again, this is where a supplement would “kick in” to pick up the 20% of allowable physical therapy expenses… but Medicare has implemented a cap. A cap refers to a therapy cap, which is the maximum amount of dollars your Medicare insurance plan will cover for out-patient physical therapy in a clinic each annual year. For the billing year of 2018 the current therapy cap = $2,010 dollars in skilled, medically necessary physical therapy services.
What if I exceed the cap? The government tried to pass a law to implement a FIRM cap, meaning no exceptions to this dollar amount no matter your pre-existing complicated conditions. GOOD NEWS! This FIRM therapy cap was overturned in the late hours of February 9, 2018 – due to active lobbying on Capitol Hill for your rights by American Physical Therapy Association (APTA) and its members who wrote their senators. I have been an active member since 2009 with the APTA and proudly support advocacy for health and wellness.
What does this mean now? The repeal came with additional consequences, one being automatic audit of any physical therapist that exceeds the $2,010 cap – but not a firm denial of payment, just an investigation into why this physical therapist or therapy company continued to treat you.
What is my point? Medicare patients need to educate themselves on insurance limitations and be given quality skilled physical therapy every session. At Moab Physical Therapy and Rehabilitation, we guarantee individual skilled therapy treatment to address your needs and help you reach YOUR goals. We do not drive up daily billing costs for unnecessary treatment or observe exercises that could be completed at home. You will work one-on-one with a licensed provider at each appointment and we do our best to keep you with the SAME licensed provider during your plan of care.
HOW does this help you? Patients at Moab Physical Therapy and Rehabilitation reach functional goals in fewer clinic sessions with lower billable insurance fees. Moab Physical Therapy and Rehabilitation strives to provide research-based techniques helping you maintain your functional improvements long after your plan of care ends. Many of us live in Moab for the community and the recreational activities it affords us. I want to help you continue to enjoy the reasons you live in Moab. If you have further Medicare questions or would like to come in for an evaluation, contact your medical doctor for a physical therapy referral. Moab Physical Therapy and Rehabilitation is located on Center Street near the Visitor Center. Follow us on Facebook at Moab Physical Therapy and Rehabilitation, or Instagram, or Twitter @MoabPT. We look forward to working with you!