Following a serious illness or surgery, it’s not uncommon to require therapy services during your recovery. But will Medicare be there to pay for these services when you need them? Do you have a Medicare supplement plan or Medicare Advantage plan to help pick up the costs left behind by Medicare?
Physical therapy may be required after major surgery such as a hip replacement. Following a stroke, it may be necessary to undergo occupational and/or speech therapy. All of these treatments are crucial to returning to your prior level of activity and functional capacity.
Medicare’s Therapy Limitations
Although Medicare does cover physical, occupational and speech therapy, there are strict guidelines and limitations in place. For 2015 these limits, or therapy caps, are as follows:
> $1,940 for physical therapy and speech therapy combined
> $1,940 for occupational therapy
To maximize your coverage, you’ll want to find out the cost of these services from a variety of facilities before undergoing therapy. Receiving treatment at an outpatient therapy center may be less expensive than a an outpatient at the hospital, which ultimately results in stretching your therapy dollars.
Out-of-pocket expenses can accumulate quickly after a sudden illness, surgery, or hospital stay. A Medicare supplement plan can help reduce your out-of-pocket expenses by picking up any deductibles and coinsurance left behind after Medicare pays for your surgery, hospital stay, or therapy services.
Are There Exceptions to Medicare’s Therapy Caps?
Of course there are exceptions to Medicare’s therapy caps, but you must follow the proper procedures to be granted an exception. First, a therapist must document that the need for continued therapy is medically reasonable and necessary. Second, when the claim is submitted for payment to Medicare, documentation that the services are medically reasonable and necessary must be included.
It’s important to remember that Medicare may review your case to determine if services are indeed medically necessary. Your provider may have you sign what’s called an “advanced beneficiary notice” advising you that it’s possible Medicare could deny your services which could result in you receiving a bill.
Do you have any questions about Medicare’s therapy service caps? Do you have any other questions our Advisors can answer for you? Learn more about Medigap Advisors
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.