Medicare covers therapy, but the type of therapy and how much you pay depends on where you receive it and which part of Medicare you have

Medicare Part B covers physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor for a medical condition. Mental health therapy (counseling or psychotherapy) is also covered under Part B. However, Medicare does not cover long-term therapy for maintenance or general wellness — only therapy aimed at improving a specific condition or regaining lost function after injury or illness.

The amount you pay out of pocket varies. After you meet your Part B deductible (which changes yearly), you typically pay 20 percent of the Medicare-approved amount for each therapy visit. If you receive therapy in a hospital outpatient department, you may pay a copay instead. Skilled nursing facilities and inpatient rehabilitation facilities have different payment rules under Part A.

The rules are complex enough that many people find it helpful to call Medicare directly at 1-800-MEDICARE before starting therapy, so you know what your costs will be.

Key Takeaways

  • Medicare Part B covers physical therapy, occupational therapy, speech therapy, and mental health counseling when a doctor orders them for a medical condition.
  • You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible, unless therapy is in a hospital outpatient setting, where you may pay a copay instead.
  • Medicare does not cover therapy for maintenance, wellness, or general fitness — only therapy to treat or recover from a specific medical condition.
  • Therapy in a skilled nursing facility or inpatient rehabilitation facility is covered under Part A, with different cost-sharing rules.
  • Calling 1-800-MEDICARE before you start therapy can tell you whether your specific therapy will be covered and what you will owe.

Physical and Occupational Therapy Under Part B

Medicare Part B covers physical therapy and occupational therapy in outpatient settings — meaning you go to a clinic, therapist's office, or hospital outpatient department, not as an inpatient. A doctor must order the therapy, and it must be medically necessary for a condition like stroke recovery, arthritis, a broken bone, or post-surgical rehabilitation.

You pay 20 percent of the Medicare-approved amount for each visit after you meet your annual Part B deductible. If the therapy happens in a hospital outpatient department, you may pay a copay instead — the amount varies by hospital. There is no yearly limit on the number of therapy visits Medicare will cover, but your therapist must document that you are making progress toward a specific goal. If progress stops, Medicare may stop covering the visits.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans can cover some or all of your 20 percent coinsurance. Medicare Advantage plans have their own rules and may require you to use in-network therapists.

Mental Health Therapy and Counseling

Medicare Part B covers outpatient mental health services, including individual therapy, group therapy, and psychiatric visits. A licensed therapist, psychologist, psychiatrist, clinical social worker, or counselor can provide the service. You do not need a doctor's referral for mental health therapy the way you do for physical therapy, though many people start by talking to their primary care doctor.

You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible. If you see a therapist who does not accept Medicare assignment, you may pay more. To find a therapist who accepts Medicare, you can call 1-800-MEDICARE or search the Medicare provider directory online.

Medicare covers therapy for depression, anxiety, grief, trauma, and other mental health conditions. It does not cover therapy for general life coaching, career counseling, or relationship information unrelated to a diagnosed mental health condition.

Therapy in Hospitals and Skilled Nursing Facilities

If you receive therapy as an inpatient — meaning you are admitted to a hospital or skilled nursing facility — the coverage and costs work differently. Inpatient rehabilitation and therapy are covered under Medicare Part A, which covers your hospital stay. You pay a deductible per benefit period, and then Medicare covers the full cost of medically necessary therapy while you are an inpatient.

After you leave the hospital or nursing facility, if you need ongoing therapy at home, that therapy is covered under Part B with the same 20 percent coinsurance rule. A doctor must order it, and a home health agency or therapist must provide it. Home health therapy is covered as long as you are homebound — meaning you cannot leave home without help or it would be medically inadvisable.

What Medicare Does Not Cover

Medicare does not cover therapy for maintenance or general wellness. For example, if you have recovered from a stroke and your therapist says you should continue exercises to maintain strength, Medicare will not cover those visits. The therapy must be aimed at improving your condition or regaining lost function, not maintaining current function.

Medicare also does not cover therapy that is not medically necessary. Massage therapy, acupuncture, and some types of alternative medicine are not covered. Therapy for cosmetic reasons or general fitness is not covered. If your doctor orders therapy but Medicare determines it is not medically necessary for your condition, you may receive a notice that the visit will not be covered and you will owe the full cost.

How to Know What Your Therapy Will Cost

Before you start therapy, ask your doctor or therapist to check whether Medicare will cover it. You can also call 1-800-MEDICARE and give them the type of therapy, the reason for it, and your specific situation. Medicare can tell you whether the therapy is covered and what your out-of-pocket cost will be based on whether you have met your deductible and whether you have Medigap or Medicare Advantage coverage.

If you receive a notice that Medicare will not cover a therapy visit, you have the right to appeal. The notice will explain how to file an appeal and the important date for doing so. Many people find it helpful to ask their therapist or doctor to help with the appeal, since they can explain why the therapy is medically necessary.

Medicare Advantage and Medigap Coverage for Therapy

If you have a Medicare Advantage plan (Part C), your coverage for therapy may be different from Original Medicare. Some Medicare Advantage plans cover more therapy visits or charge lower copays. Others may require you to use in-network therapists or get prior approval before starting therapy. Check your plan's summary of coverage or call the plan directly to find out what therapy is covered.

If you have a Medigap plan, it does not change what Medicare covers — it only helps pay your share of the cost. Medigap plans cover some or all of your 20 percent coinsurance and your deductible, depending on which Medigap plan you have. This means your out-of-pocket cost for therapy is lower with Medigap than with Original Medicare alone.

Frequently Asked Questions

Does Medicare cover therapy for depression or anxiety?

Yes. Medicare Part B covers outpatient mental health therapy for depression, anxiety, and other mental health conditions. You pay 20 percent of the Medicare-approved cost after meeting your deductible. You do not need a referral from your doctor, though many people start by talking to their primary care doctor.

Will Medicare cover physical therapy at home?

Yes, if you are homebound and a doctor orders it. Home health therapy is covered under Part B. You must be unable to leave home without help or it would be medically inadvisable. A home health agency or therapist must provide the service, and you pay 20 percent of the approved cost after your deductible.

What happens if my therapist says I need more visits but Medicare stops covering them?

Medicare stops covering therapy when it determines you are no longer making progress toward a specific goal. If you disagree, you can appeal. Ask your therapist or doctor to help explain why continued therapy is medically necessary. The notice you receive will explain how to file an appeal and the important date.

Does Medicare cover therapy if I have a Medicare Advantage plan?

Medicare Advantage plans must cover at least what Original Medicare covers, but many cover more. Some plans offer more therapy visits or lower copays. Check your plan's coverage document or call the plan to find out what therapy is covered and whether you need prior approval.

Do I need a doctor's order for mental health therapy?

No. Unlike physical therapy, you do not need a referral for mental health counseling. You can contact a therapist directly. However, many people find it helpful to start with their primary care doctor, who can provide a referral or help you find a therapist who accepts Medicare.