Physical therapy and occupational therapy can be excellent options to help you heal from an injury or after surgery. However, you may wonder about how the costs of physical therapy and occupational therapy add up. Here’s a brief guide to physical therapy and occupational therapy. The first part of this article will focus on the costs involved if the person you care for has Medicare (health insurance for those age 65 and up) and we’ll round it out with a few notes on what to expect if you are using private insurance.
How Much Does Physical Therapy Cost?
Physical therapy has several functions and benefits:
- To help you recover from an injury.
- To aid with and reduce pain.
- Help you get better after a surgery, such as hip replacement, knee replacement, and many other types of surgery.
- To improve function with a variety of chronic conditions and illnesses.
Typically, with physical therapy, you’ll attend a first session where the physical therapist will ask you questions about why you are there. The physical therapist will assess your ability to make certain types of movements, to find out how your problem limits mobility.
Then, the physical therapist will use a variety of exercises, equipment, and resources to help you recover. This can include stretches, massage, ultrasound, and a variety of other tools.
Physical therapists often recommend two to three sessions a week for several weeks. After that time, as you begin to recover, you will return for fewer sessions. The number of sessions a person has will depend on their progress. Insurance coverage also may guide the number of sessions.
Because physical therapy involves several sessions and can extend for several weeks, it’s only natural to wonder what types of costs are involved when you have Medicare. Here’s the scoop:
If you have Medicare Part B, then Medicare will cover physical therapy provided that it is medically necessary.
Here is how Medicare determines that physical therapy is medically necessary:
- Physical therapy is needed to diagnose or treat a condition or illness.
- The treatment is part of accepted standards of medicine.
- Your doctor recommends therapy to treat your condition.
If the senior loved one you care for has Medicare Advantage, then physical therapy is also covered, and you may have some other benefits as well. If you have Medicare Advantage, it’s best to take a look at your plan to find out coverage specifics for physical therapy.
When you have Medicare Part B, your out-of-pocket cost for physical therapy is 20% of the amount charged for therapy approved by Medicare.
Patients pay 20% of the Medicare-approved amount for physical therapy. For example, if each visit is $125, then your portion–the 20%–would be $25.
If your physical therapist charges more than the Medicare-approved amount for treatment, you must pay the difference.
You also must first meet your Part B deductible – $233 in the year 2022. The deductible can be for any type of health charge that falls under Medicare, not just physical therapy. Once you meet your deductible, you pay 20%.
The amount you pay for physical therapy with Medicare Advantage will vary more and will depend on your specific plan. Make sure to check with your specific plan for information.
If it’s medically necessary, then Medicare also will cover in-home physical therapy. This will apply if the person cannot leave the home to go to in-office appointments. The coverage for this falls under Medicare Part A, which includes home care.
How Much Does Occupational Therapy Cost?
Occupational therapy helps people with their activities of daily living after an injury, illness, or with a disability. This can include assistance with balance, coordination, and motor skills. For instance, after a hand injury or hand surgery, a person may need help using silverware again. Getting dressed and taking a bath are two other tasks that an occupational therapist may address with a person who is having trouble in these areas.
Like physical therapy, occupational therapy will involve an initial assessment and a treatment plan. A person receiving occupational therapy may initially have two to three appointments a week for a couple of weeks. This frequency will decrease as they make progress.
The coverage for occupational therapy is similar to the coverage for physical therapy. When you have Medicare Part B, your out-of-pocket cost for occupational therapy is 20% of the amount charged for therapy approved by Medicare.
Patients pay 20% of the Medicare-approved amount for occupational therapy. For example, if each visit is $100, then your portion–the 20%–would be $20.
If your occupational therapist charges more than the Medicare-approved amount for treatment, you must pay the difference.
You also must first meet your Part B deductible – $233 in the year 2022. The deductible can be for any type of health charge that falls under Medicare, not just occupational therapy. Once you meet your deductible, you pay 20%.
With Medicare Advantage, the amount of money you pay for occupational therapy will vary more and will depend on your specific plan. Check with your specific plan for information.
The Cost of Physical Therapy and Occupational Therapy When You Have Private Insurance
A person with private insurance instead of Medicare should check with their specific plan regarding coverage for physical therapy or occupational therapy. The plan may cover a certain number of appointments or a percentage of the costs (for instance, they may cover 80% of the cost while the remaining 20% is paid out of pocket). If the cost for these appointments adds up, you can always talk to the physical or occupational therapy office about a monthly payment plan.
If you do not have insurance, ask about the self-pay cost for physical therapy or occupational therapy. Offices may be able to offer a less expensive “cash pay” rate because they don’t have to go through the hassles of insurance. (You don’t have to actually pay cash, you can use a card–they are just called “cash pay” or “self-pay.”) Again, if you know that you need physical or occupational therapy but do not have insurance, ask about payment plans. Also, inquire about assistance programs in your area that will help you cover the cost of therapy.