Medicare B - Demystified!
As a ‘Medicare B’ therapy practice, we hear all sorts of crazy myths and misconceptions that often keep people from getting the care they need. Read on to hear about the top 5 Medicare Myths and learn how you can make the most of your Medicare B Therapy Benefit.
Myth #1: You can ONLY have At-Home PT AFTER you have a hospital stay.
WRONG! Busting this myth requires a quick breakdown the different types of Medicare benefits.
Medicare A covers anything INPATIENT: Hospital stays, rehab stays and the type of In-Home PT that happens when you receive VNA (visiting nursing agency) care. You must be HOMEBOUND to receive this level of care.
Medicare B covers anything OUTPATIENT: Doctor visits, imaging and outpatient rehabilitation. HOWEVER, your outpatient therapists CAN provide services at a clinic OR in your home. This is how Healthy Aging Physical Therapy operates - we are a Medicare B credentialed rehab clinic who offers AT-HOME Physical and Occupational Therapy. And bonus, you don't HAVE TO BE homebound to receive Medicare B covered therapies.
So, now we can BUST this common Medicare Myth and confirm you CAN have At-Home PT at any time - whether you've been at at a hospital, had PT suggested by your doctor, or simply think you could benefit from our services.
Myth #2: You've got to see your doctor FIRST to get a referral for At-Home Physical Therapy.
WRONG! Physical Therapists are 'Direct Access' clinicians, which means we can see you FIRST, and without a referral from a physician if you are a Medicare beneficiary. While it is our responsibility to send our evaluation on your PCP for certification, you do NOT need to see your doctor first to get a referral for At-Home Physical Therapy.
Myth #3: There is a 'Cap' on how many PT visits you can have each year.
WRONG! The idea that there is a 'cap' on how many visits you can have each year is OUTDATED and INCORRECT. Medicare B covers Physical Therapy as long as it is 'Medically Necessary' and there is no set number of visits you can 'have' each year.
What does 'Medically Necessary' mean? It means you have a physical impairment, or multiple physical impairments, that impair your ability to function and participate fully in the every-day activities of your daily life. While you don't 'run out' of visits, a physical therapist may determine you no longer qualify for skilled physical therapy when you have made enough progress that it is no longer medically necessary - or when you are independently able to maintain your health and wellness without further skilled intervention.
Myth #4: If I stop improving, Medicare will stop paying for my therapy
.
WRONG! Although this myth requires a little more nuance, there are situations in which Medicare will continue to cover care, even if you have improved as much as you likely will - or even if you are getting worse.
Medicare B will cover what they call 'Maintenance Therapy,' if these services are necessary to keep an individual from progressing towards further disease or disability IF such a program continues to warrant the skills of a licensed physical therapist. Sometimes this requires weekly visits, and more often, monthly or every few months to check in, assess the effectiveness of the program and make changes as indicated.
Clinically, this kind of therapy can be CRITICAL to someone living with a chronic disease. These check-ins can allow us to identify problems early, before they become bigger issues, and keep you on the right track without so many ups and downs.
Myth #5: You can't see us for PT if you have a MEDICARE ADVANTAGE plan because we are 'Out of Network'. .
WRONG! Even though we are not enrolled with many managed plans (Blue Cross Blue Shield is the exception!), almost every Medicare Managed Plan has Out of Network Benefits. This means you can choose to see a provider that is willing to bill on your behalf and 'accept assignment' for your care. Healthy Aging Physical Therapy is happy to see you even if you have an Medicare Advantage Plan, like Tufts Medicare, AARP or United Health Care, if you have Out of Network benefits. Not sure if your plan covers Out of Network therapists? Just ask:) We're happy to call your insurance for you to check, and do the leg work to get a referral in place to get you the best care possible.
Here are 5 great reasons to use your Medicare B Benefit to see a physical therapist:
1) If you've had a fall or are worried about falls.
2) If you're having a harder time moving around your house
or out and about in the community.
3) If you're feeling weaker or more unsteady on your feet.
4) If pain is making it harder for you to walk, to take care of
yourself, your loved one or your home
5) If you've had a recent hospitalization, illness or injury.
Interested in Therapy with Healthy Aging PT?
