If your doctor recently recommended you go to occupational therapy, you may have some questions on your mind, including how much it will cost. Here’s what you need to know about occupational therapy and Medicare.
Occupational therapy is a therapy designed to help individuals perform daily activities, such as bathing, dressing, or managing medications. This type of therapy may be recommended by a doctor for several reasons, including if the person has experienced a recent physical or cognitive change, which may be due to an injury or illness. The goal of occupational therapy is to enable individuals to maintain their current physical abilities or to slow the decline of their abilities.
Generally, occupational therapy services include:
• A personal evaluation to determine the individual’s goals
• Individualized interventions to improve the person’s ability to perform certain tasks and meet their goals
• An outcome evaluation to determine if the goals are being met and/or if any changes should be made to the therapy plan
Some occupational therapy services may include an evaluation of the person’s home and suggestions for adaptive equipment, as well as training on how to use the equipment.
For those on Medicare, Medicare Part B (medical insurance) helps cover the cost of outpatient occupational therapy. However, your doctor or other health care provider must deem it medically necessary.
After you meet the 2023 Part B deductible of $226, you will pay coinsurance for 20 percent of the Medicare-approved cost, while Medicare will pay for the remaining 80 percent. You will continue to pay your monthly Part B premium of $164.90 (this is the cost for most Medicare beneficiaries) as well. Your out-of-pocket costs could vary based on whether you have a Medicare Supplement or a Medicare Advantage plan.
Durable medical equipment might be recommended by your occupational therapist and could be covered by Part B (as outlined above) if medically necessary. That may mean that you will be required to rent equipment versus buying it, depending on Medicare’s guidelines for the specific piece of equipment.
It’s important to know that there’s no cap on the amount Medicare will pay for your occupational therapy services in a year, so long as they are medically required.
Keep in mind that the total amount you pay will be dependent on the type of occupational therapy services your doctor recommends and the Medicare plan you have. As always, our client advisor team can walk you through any questions you have about your personal situation.
Your doctor or occupational therapist may recommend treatment beyond what is considered medically necessary by Medicare, such as additional sessions or services that aren’t covered by Medicare. If so, you will be required to pay for that portion of your treatment out of pocket.
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