Marci’s Medicare Answers: Does Medicare cover outpatient physical therapy?

Dear Marci,

I just signed up for Original Medicare and I need to get physical therapy. Does Medicare cover outpatient physical therapy?


Dear Nick,

Yes, Medicare will help pay for outpatient physical therapy as long as the following requirements are met:

•The service is medically necessary;

•Your doctor or therapist sets up a plan of treatment; and

•Your doctor periodically reviews the plan to see how long you’ll get therapy.

Generally, Medicare will only cover physical therapy if your condition can improve or if your condition will get worse without therapy.

You may be able to get physical therapy as an outpatient of a participating Medicare hospital, skilled nursing facility, home health agency, outpatient rehabilitation facility, or public health agency. Also, you may be able to get physical therapy from a privately practicing, Medicare-approved physical therapist in the therapist’s office or in your home.

Keep in mind that in 2012, Medicare will cover up to $1,880 for physical and speech therapy costs combined. After you pay the annual Medicare Part B deductible ($140 in 2012), Medicare will pay up to 80 percent of the approved amount for each service. You will be responsible for the remaining 20 percent coinsurance. After the $1,880 limit has been reached, you will have to pay the full cost of any physical therapy you receive. However, you may be able to get Medicare to cover additional physical therapy.

If you are approaching the $1,880 limit and need more therapy, your doctor can tell Medicare that it’s medically necessary for you to get more therapy. Remember, if Medicare denies the claim, you can always appeal.


Dear Marci,

I am thinking about changing my drug coverage during the Fall Open Enrollment Period. What are some things I need to know before making any changes to my drug coverage?


Dear Constance,

You can make changes to your health or drug coverage during Fall Open Enrollment, which spans from Oct. 15 to Dec. 7 of each year. During this time, you can make as many changes to your health or drug coverage as you’d like, and the last change you make will take effect Jan. 1 of the following year. When you are choosing prescription drug plans, it might be helpful to ask the following questions:

•Are my medications listed on the plan’s list of covered drugs (formulary)?

•What are the premium, deductible and copay amounts I must pay under the plan?

•Are my pharmacies in the plan’s preferred network so I pay the lowest amount?

•Does the plan have any rules I need to follow in order to get my prescription drugs?

Keep in mind that if you have a Medicare private health plan that provides health and drug coverage (Medicare Advantage plan), switching drug plans will affect your health coverage. However, if you have Original Medicare and a separate Part D plan that just covers drugs, you can switch Part D plans and keep your current health coverage.

You may also find it helpful to use Medicare’s PlanFinder tool, which can give you a comprehensive list of Medicare Advantage and Part D plans, the drugs they cover, and their costs. You can access PlanFinder by calling Medicare at 800-633-4227 or online at


Dear Marci,

I recently signed up for Medicare and my Part B premium is being taken out of my Social Security check each month. I cannot afford to pay my premiums. Are there any programs that can help me pay for Medicare Part B?


Dear Darrell,

Yes, you might qualify for a Medicare Savings Program, which is an assistance program that helps people with limited income pay for the Medicare Part B premium. There are three common MSPs, and each one has different eligibility limits. The three main MSPs are:

•Qualified Medicare Beneficiary.

•Specified Low-Income Medicare Beneficiary.

•Qualifying Individual.

To qualify for an MSP, you must have Medicare Part A and meet income and asset state guidelines. MSP eligibility limits vary by state, so you should contact your State Health Insurance Assistance Program to see if you qualify for an MSP.


Marci’s Medicare Answers is a service of the Medicare Rights Center (, the nation’s largest independent source of information and assistance for people with Medicare.

To speak with a counselor, call 800-333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply email dearmarci@medi

To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at

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