Does Medicare Pay for Physical Therapy at Home?

Medicare, a federal health insurance program, serves individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Managed by the Centers for Medicare & Medicaid Services (CMS), Medicare aims to help eligible individuals manage healthcare costs. The program offers various coverage types, designed to address diverse health needs and service delivery methods. Understanding Medicare’s structure helps beneficiaries navigate their options for medical care.

Meeting Medicare’s Home Health Eligibility

Accessing physical therapy at home through Medicare requires meeting specific home health eligibility criteria. A physician must certify that home health care is medically necessary for the patient.

The patient must be considered “homebound.” Medicare defines homebound as having difficulty leaving home without assistance, such as using a cane, wheelchair, or crutches, or needing help from another person. Leaving home must also be a considerable and taxing effort, or medically contraindicated due to the individual’s condition. While generally unable to leave home, brief, infrequent absences for medical appointments, religious services, or adult day care are permitted without jeopardizing homebound status. This status ensures that home health services are provided to those whose conditions significantly restrict their ability to travel for care.

The patient must also require intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy. These services must be provided by a Medicare-certified home health agency.

Specific Physical Therapy Services Covered

Once an individual meets Medicare’s home health eligibility, specific physical therapy services are covered if deemed “reasonable and necessary” for their condition. This means the therapy must be specific, safe, and effective in treating an illness or injury. Medicare covers physical therapy aimed at improving an individual’s condition, maintaining their current function, or slowing the decline of a chronic illness. This coverage dispels the misconception that Medicare only pays for therapy showing continuous improvement.

Physical therapy interventions covered in the home setting include therapeutic exercises to improve strength and mobility, gait training to enhance walking ability, balance activities to reduce fall risk, and pain management techniques. The frequency and duration of these visits are determined by a personalized care plan, developed by the home health agency and reviewed by a physician.

Skilled physical therapy services are performed by or under the supervision of a licensed therapist. Medicare’s coverage ensures that individuals recovering from surgeries, injuries, or managing chronic conditions can receive targeted rehabilitation in their home environment. The goal is to help patients regain function, prevent disability, and enhance their overall quality of life.

Understanding Your Costs

Medicare Part A, which covers hospital insurance, pays for eligible home health services, including physical therapy, when all necessary criteria are met. For these covered home health services, beneficiaries pay $0 out-of-pocket.

While the direct cost for physical therapy visits is often zero, patients may incur costs for durable medical equipment (DME) if needed as part of their treatment plan. Medicare Part B covers DME, with beneficiaries responsible for 20% of the Medicare-approved amount after meeting their annual Part B deductible. For 2025, the Part B deductible is $257. Examples of DME include walkers, canes, or hospital beds, which must be prescribed by a doctor for use at home and obtained from a Medicare-enrolled supplier.

Medigap policies, also known as Medicare Supplement Insurance, can help cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles and coinsurance. Medicare Advantage Plans, offered by private companies, must provide at least the same level of benefits as Original Medicare, but they may have different cost-sharing structures, including varying premiums, deductibles, and copayments. Beneficiaries with these plans should consult their specific plan details for cost information.

Steps to Access Home Physical Therapy

Initiating home physical therapy under Medicare begins with obtaining a physician’s order for home health services. The physician must certify the patient’s need for these services and create a comprehensive plan of care.

After securing the physician’s order, the next step involves choosing a Medicare-certified home health agency. Beneficiaries can use Medicare’s “Care Compare” tool on Medicare.gov to find and compare agencies in their area based on quality ratings.

Once an agency is selected, their staff will conduct an initial assessment of the patient’s health and care requirements. This assessment informs the development of a personalized care plan, detailing specific physical therapy goals and interventions. The care plan specifies how often services will be received and outlines expected treatment outcomes.

Receiving services then involves scheduled home visits from the physical therapist or assistant, adhering to the established care plan. The home health agency maintains communication with the patient’s doctor, updating them on progress and making any necessary adjustments to the care plan. If a patient’s condition changes, the home health team will inform the provider promptly to ensure continuous appropriate care.