Medicare covers therapy, but the type of therapy, how much it pays, and what you pay out of pocket depend on where you receive care and which part of Medicare you have

Medicare Part B covers physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor and provided by a licensed therapist. It also covers mental health counseling and psychiatric services at the same rate as other doctor visits. The coverage exists, but it comes with limits on the number of visits per year, rules about where you can receive care, and your own costs — usually 20 percent of what Medicare approves after you meet your Part B deductible.

If you have a Medicare Advantage plan (Part C), your coverage for therapy may differ. Some Advantage plans cover more therapy visits than Original Medicare, some cover fewer, and some add benefits like acupuncture or chiropractic care that Original Medicare does not. You will need to check your specific plan's coverage document or call the plan directly.

Key Takeaways

  • Original Medicare Part B covers physical therapy, occupational therapy, speech therapy, and mental health counseling when a doctor orders them, and you pay 20 percent of the approved cost after your deductible.
  • Medicare sets an annual limit on how many therapy visits it will pay for in a calendar year, though your doctor can request an exception if medically necessary.
  • Therapy must be medically necessary — meaning it treats a condition or injury and aims to improve function — not maintenance or wellness.
  • Medicare Advantage plans set their own therapy coverage limits and may cover different types of therapy than Original Medicare does.
  • Outpatient therapy in a clinic, hospital, or your home is covered; therapy in a skilled nursing facility or inpatient hospital stay follows different rules.

How Much Medicare Pays for Each Type of Therapy

Medicare Part B covers the therapist's fee at 80 percent after you pay your annual deductible (which is $240 in 2024, though this amount changes yearly). You are responsible for the remaining 20 percent. The actual dollar amount depends on what Medicare approves for that service in your area — it is not the same everywhere.

For example, if Medicare approves $100 for a physical therapy session and you have met your deductible, Medicare pays $80 and you pay $20. If you have not met your deductible yet, you pay the full amount until the deductible is satisfied, then the 80/20 split begins.

If you have a Medigap supplemental insurance plan, it may cover some or all of your 20 percent share, depending on which Medigap plan you own. If you have Medicaid in addition to Medicare, Medicaid may cover costs that Medicare does not. Check your plan documents or call your insurance company to know what your actual out-of-pocket cost will be.

Annual Visit Limits and Medical Necessity Rules

Medicare sets an annual limit on therapy visits. For physical therapy and occupational therapy combined, the limit is currently 60 visits per calendar year. Speech-language pathology has its own 60-visit limit. These limits reset on January 1 each year.

The visits must be medically necessary, which means a doctor has ordered them to treat a specific condition — such as recovery from a stroke, a broken hip, arthritis, or a speech disorder — and the therapy is expected to improve your function or ability to perform daily tasks. Medicare will not pay for therapy aimed only at maintaining current function or for general wellness.

If your doctor believes you need more than 60 visits in a year, they can request an exception from Medicare, called a manual review or exceptions request. Medicare will review the medical records and decide whether to approve additional visits. This process takes time — usually several weeks — so plan ahead if you think you will need it.

Mental Health Counseling and Psychiatric Care

Medicare Part B covers mental health services at the same rate as physical health services: you pay 20 percent of the approved cost after your deductible. This includes visits with a psychiatrist, psychologist, licensed clinical social worker, or licensed professional counselor.

Unlike physical therapy, mental health visits do not have an annual visit limit. You can see a mental health provider as often as your doctor orders and Medicare approves as medically necessary. However, the provider must be enrolled in Medicare and accept Medicare payment.

If you are in a Medicare Advantage plan, check your plan's coverage for mental health services — some plans offer additional benefits like telehealth counseling or a higher number of covered visits.

Where You Can Receive Therapy and How Location Affects Coverage

Medicare covers therapy in several settings: an outpatient clinic, a hospital outpatient department, your home (if a doctor orders home health therapy), and a skilled nursing facility (if you are a resident). The rules and your costs are the same across these settings — you still pay 20 percent after your deductible.

If you receive therapy as part of an inpatient hospital stay or in a skilled nursing facility where you are staying, the costs work differently. Inpatient hospital therapy is covered under your Part A hospital benefit, not Part B. Skilled nursing facility therapy is also covered under Part A if you meet the admission requirements (a 3-day hospital stay first, and admission within 30 days of discharge).

Private pay therapy — therapy you arrange and pay for yourself without a doctor's order — is not covered by Medicare. Some people choose this route if they want more visits than Medicare allows or if they prefer a provider Medicare does not cover.

Medicare Advantage Plans and Therapy Coverage

If you have a Medicare Advantage plan, your therapy coverage is set by your plan, not by Original Medicare. Some Advantage plans cover the same 60-visit limit as Original Medicare. Others cover more visits — 80, 100, or even unlimited visits. Some cover fewer. You will find this information in your plan's Summary of Benefits and Coverage document, which your plan mails to you each fall or which you can request by phone.

Many Advantage plans also cover therapy types that Original Medicare does not, such as acupuncture, chiropractic care, or massage therapy. If these services matter to you, compare plans during the annual open enrollment period (October 15 to December 7 each year) to find a plan that includes them.

If you switch from Original Medicare to an Advantage plan or vice versa, your therapy coverage will change. If you are in the middle of therapy, contact your new plan or Medicare to understand how the change affects your ongoing care.

How to Start Therapy and What to Tell Your Doctor

To receive Medicare-covered therapy, you need a doctor's order. This can come from your primary care doctor, a specialist, or a hospital discharge planner. Tell your doctor what you are struggling with — difficulty walking after a fall, trouble speaking after a stroke, pain that limits your movement — and ask whether therapy might help.

Your doctor will write an order that specifies the type of therapy (physical, occupational, or speech), the frequency (how many times per week), and the duration (how many weeks). This order goes to the therapy provider, who will verify with Medicare that the therapy is covered and that you have not exceeded your annual visit limit.

Before your first appointment, ask the therapy provider to confirm that they accept Medicare and what your out-of-pocket cost will be. Bring your Medicare card. If you have a Medigap or Medicaid card, bring those too — the provider may need them to bill correctly.

Frequently Asked Questions

Does Medicare cover therapy for arthritis or chronic pain?

Yes, if a doctor orders physical therapy or occupational therapy to improve your function and reduce pain from arthritis or another chronic condition. The therapy must aim to help you move better or do daily tasks more easily, not just manage pain. If your doctor believes therapy will help, ask for an order.

What happens if I run out of visits before the end of the year?

Once you reach 60 visits for physical or occupational therapy in a calendar year, Medicare will not pay for more visits unless your doctor requests and Medicare approves an exception. You can pay out of pocket for additional therapy, or you can wait until January 1 when your visit count resets.

Does Medicare cover therapy through telehealth?

Yes. Medicare covers mental health counseling via telehealth at the same rate as in-person visits. Physical therapy and occupational therapy via telehealth are covered in some cases, particularly if you live in a rural area or have difficulty traveling. Ask your provider whether they offer telehealth and whether Medicare will cover it.

Can I choose any therapist, or does Medicare have a list?

The therapist must be licensed and enrolled in Medicare. You can choose any enrolled provider, but not all therapists accept Medicare. Call ahead to confirm the provider accepts Medicare and has availability. Your doctor or local hospital can also refer you to Medicare-enrolled therapists in your area.

If I have a Medicare Advantage plan, do I still pay 20 percent for therapy?

Your cost depends on your specific Advantage plan. Some plans charge a copay per visit (for example, $25 per therapy visit), others charge coinsurance (a percentage), and some charge nothing after you meet a deductible. Check your plan documents or call your plan to find out your exact cost.