using up the PT benefit

[spncity]

Not sure how best to ask. How do I find out "how much" Medicare will pay in a year for PT ?

Does it go by "occurence"? As in - if you supposedly use up the benefit for the year, but you somehow suffer a new injury on the same body part, or you injure a different part of your body, is there a different benefit "bucket" that will cover PT for that new injury?

Not the same, but I remember when helping my mom years ago, there was one year that she needed to stay out of the hospital for 90 days so her Medicare benefit would "reset" and would then be available to cover another hospitalization in that calendar year. From what I remember, she didn't need another hospitalization, but I was holding my breath during that 90 days.

Thanks for any comments!

 

[harllee]

Are you asking about traditional Medicare or Medicare Advantage? At one time there was a limit on the number of physical therapy visits traditional Medicare would pay in a year (I think it was 100 hundred visits) but it is my understanding that limit is gone and traditional Medicare has no annual limit on the number of physical therapy benefits. There are probably different rules for Medicare Advantage policies.

 

[Aerides]

Your PT facility will usually tell you what is covered, how many visits, etc., when you go for the first time. (ps, if you need more than medicare covers, pay for it, PT for recovery is gold)

 

[aja8888]

To get PT, a doctor has to write an order for Medicare to cover it.

 

[Peter]

To get PT, a doctor has to write an order for Medicare to cover it.

And in my wife's recent experience, if the doctor writes an order, it's covered, no questions.

 

[old medic]

I don't know about Medicare, But BCBS was unlimited while inpatient at the hospital, the approved 30 hour sessions after discharge. Will find out today what has been approved since I'm starting again.

 

[spncity]

Yes, original Medicare and Medigap G plan. Thank you for these and future comments.

Agree one should not skimp on PT.

I didn't want to find out later (from being uninformed now) whether I could use it all up and be out of luck if something happened later.

 

[Gotadimple]

spncity:
Medicare Advantage is allowed to limit the number of PT visits - but it depends on the insurer and the plan. The number of allowed visits is stated in the Medicare Advantage Evidence of Coverage.

It might be useful to call your Medicap plan and ask if there is a limit - there shouldn't be. If there is then ask if it restarts once you hit your annual renewal.

 

[MissMolly]

spncity:
Medicare Advantage is allowed to limit the number of PT visits - but it depends on the insurer and the plan. The number of allowed visits is stated in the Medicare Advantage Evidence of Coverage.

It might be useful to call your Medicap plan and ask if there is a limit - there shouldn't be. If there is then ask if it restarts once you hit your annual renewal.

Not true. Since Medicare no longer limits physical therapy then Medicare Advantage plans are not allowed to limit pt sessions.

https://boomerbenefits.com/does-medicare-cover-physical-therapy/

 

[pacergal]

The times I have had PT while on medicare, 8 visits were initially authorized, but I could get more if needed.
Usually, after that many visits, I knew what the exercises were and could do them at home. The only thing I missed at that point was the muscle massage in the beginning to break up scar tissue and the heat packs at the end!

 

[badatmath]

I don't know about Medicare, But BCBS was unlimited while inpatient at the hospital, the approved 30 hour sessions after discharge. Will find out today what has been approved since I'm starting again.

Hmm, my BCBS has 100 visits a year. IDK if that covers inpatient and out since I was never "in"- it is just what the PT place told me.

I was a bit shocked to see how much less the new PT place charges than the first one I left for lack of results. IDK if this is worth shopping for if you have a high deductible but possibly. (I've met mine now so kind of immaterial as I only pay 10% of allowed amount).

I've never been super impressed with PT - this is my fourth one over say 10 years and 2 were down right useless.

 

[RetiredHappy]

I have gone through PT series at least a dozen times in my life. They were all useless except for the massages and TENS on my golfer's and tennis elbows. Thereafter I bought a TENS unit to work on my elbows at home. PT didn't work for my bad hip, bad knee, bad shoulders and bad back. I am always surprised when people tell me how great PT is for their recovery. It is possible that they are effective after major surgeries for shouder, hip and knee replacements. I have not undergone these surgeries.

 

[aja8888]

I have gone through PT series at least a dozen times in my life. They were all useless except for the massages and TENS on my golfer's and tennis elbows. Thereafter I bought a TENS unit to work on my elbows at home. PT didn't work for my bad hip, bad knee, bad shoulders and bad back. I am always surprise when people tell me how great PT is for their recovery. It is possible that they are effective after major surgeries for shouder, hip and knee replacements. I have not undergone these surgeries.

Both my hips were replaced using the anterior procedure (from the front) and the Doc did not prescribe PT...he said just get out there and walk daily, which I did on day two onward and it all worked out just fine.

 

[old medic]

Will find out today what has been approved since I'm starting again.

I again have 30, one hour sessions approved.

 

[Aerides]

I again have 30, one hour sessions approved.

I think that's what my ACA BCBS plan covers. I've also checked and the out of pocket if I went beyond that is barely more than the price I pay pre-deductible anyway, if I ever needed more.

But the best thing to do when you're winding down on the covered visits is to ask for exercises you can do at home, or your gym, with the equipment you have access to, so you can continue them.

 

[old medic]

But the best thing to do when you're winding down on the covered visits is to ask for exercises you can do at home,/QUOTE]

Whats been great is I have been working with the same folks since I was inpatients. When cleared to go back they were surprised to see my progress from the last session on December 27th. One ran up and hugged me. I have a bunch of exercise's to do as I can, and going back about every week and a half. Also tring to get a game plan together to pre-treat the left leg for the rod replacement in July.