Question from Caring.com Community Member, john1
I have been diagnosed with Parkinson's. Will Medicare pay for a physical trainer, physical therapy, and massage therapy?
Expert Answer by Joseph L. Matthews
Joseph L. Matthews is a Caring.com senior editor, an attorney, and the author of Long-Term Care: How to Plan & Pay for It and Social Security, Medicare, & Government Pensions: Get the Most Out of Your Retirement & Medical Benefits.
Medicare Part B can cover outpatient physical therapy, occupational therapy, and speech therapy as prescribed by your doctor. Neither a physical trainer nor a massage therapist is covered by Medicare, but similar services may be part of what's provided by a physical therapist who's experienced with Parkinson's patients.
Although Medicare Part B "covers" physical therapy, that doesn't mean it pays the entire cost. For any session of physical or other therapy, Medicare pays 80 percent of the total amount it approves for those services. You must pay the other 20 percent out of your own pocket, unless you have a Medigap supplemental insurance policy that covers physical therapy. Also, if you haven't already paid the general yearly Part B deductible of $135, you have to pay that out of your pocket before Medicare will pay for any therapy.
There are also yearly limits on the total amount Medicare will pay for covered therapy. In 2008, Medicare Part B will pay its share only up to total bills of $1,810 for physical and speech therapy combined, and up to another total of $1,810 for occupational therapy bills.
Once you reach these yearly limits, there are still two ways you might get Medicare to pay for more therapy. The first is to ask your doctor and physical therapist to request that Medicare grant an "exception," if the doctor and therapist believe that your condition makes additional therapy "medically necessary." You don't have to do anything except ask them to make the request for you.
The other way to get Medicare to pay for additional therapy is to get the therapy from a hospital outpatient department.There's no yearly limit on Medicare payments for medically-necessary, physician-prescribed outpatient therapy services if you get them in a hospital outpatient department. On the other hand, a hospital outpatient department can charge you more than the Medicare-approved amount for its services, so that you'd personally owe not only 20 percent of the Medicare-approved total amount but also any amounts over that total.
