Occupational therapy is a viable option to help patients recover from surgery, illness, or an accident. In addition, Medicare patients can benefit from the expertise of an occupational therapist in the areas of fine and basic motor skills, which can make even the most mundane tasks more manageable. Medicare reimburses occupational therapy treatments if they are deemed medically essential. Therefore, depending on your specific conditions, Medicare will cover all or some occupational services. 

So, let’s see what those conditions are, what is covered, and how much you may have to pay. But, before that, here’s a brief about Occupational Therapy Medicare Coverage.

What is Occupational Therapy?

Occupational Therapy is a kind of treatment that helps you do your job or schoolwork, care for yourself, complete household chores, move around, or take part in other activities, only if you have a limiting pain, injury, illness, or disability.

Your fine and basic motor skills can be improved through occupational therapy. In addition, increased independence and self-sufficiency may enhance your well-being and quality of life.

After a severe injury, occupational therapy (OT) can help you regain strength, stability, and balance to become safe and independent again. In addition, you may benefit from it if you have a long-term illness or disability.

Medicare covers what aspects of occupational therapy?

Many of life’s responsibilities may become more challenging to perform due to an illness, injury, or surgery. For example, if all you need to do is comb your hair, brush your teeth, or get dressed for the day, you will need assistance. However, working your way back into your routine can be achieved through occupational therapy (OT).

Fortunately, Original Medicare covers occupational therapy. Part A and B will cover you while you’re in the hospital and after you’ve been discharged. 

Part C (Medicare Advantage) programs provide the same level of coverage as Original Medicare, but they might have some differences depending on your plan.

Medical insurance (Medigap) may cover some of your deductibles and copayments. Here’s a more detailed overview of each plan.

Part A Coverage

Anyone recently diagnosed with an illness or who has seen their condition deteriorate may benefit from the services of an occupational therapist. Part A covers medically necessary therapeutic care or rehabilitation as an inpatient stay.

Part B coverage

If suggested on an outpatient basis, medically necessary occupational therapy will be covered under Medicare Part B.

However, make sure that the provider accepts Medicare. OT programs can provide the following services. It;

• Determines your ability to eat and swallow and other aspects of daily living.
• Tailor your care to your specific requirements and objectives, assessing your living and working environments to see if you need adaptive equipment like safety bars in the bathroom.
• Weight-bearing and balance training exercises to improve flexibility.
• Provide medical equipment training for you and your caregivers, including canes and walkers.
• Offer safety education for your caregivers, such as safely transferring you in and out of the car.

Part C coverage

Medicare Advantage (Part C) plans provide coverage as extensive as traditional Medicare (Parts A and B). In addition, these plans will cover OT services for both inpatient and outpatient care. 

However, some rules may differ depending on your enrolled plan. Discuss it with your provider to know whether your coverage differs from Original Medicare regarding occupational therapy.

What costs should I expect?

Your out-of-pocket expenses may differ depending on which part of Medicare covers your occupational therapy services. Here are some of the costs you may have to pay out-of-pocket based on each part.

Part A costs

A $1,556 hospital deductible per benefit period applies if your claim is covered by premium-free Part A. However, you have to pay the amount out of pocket before Medicare starts to pay its share.

If your stay exceeds 60 days within a benefit period after you’ve met your deductible, you’ll be responsible for the inpatient coinsurance costs, i.e., $389 per day.

Part B costs

Occupational therapy (OT) costs approved by Medicare ask you to pay a 20% copayment after the annual deductible of $203 has been met once eligible for coverage.

Most Medicare beneficiaries’ typical monthly Part B premium will remain at $170 in 2022.

Part C costs

For those with Medicare Advantage plans under Part C, your out-of-pocket expenses will be determined by your specific plan.

Your insurance provider’s website and the proof of coverage form you receive each September should include information on out-of-pocket expenses. If you’d like to learn more about the costs involved, you can directly reach out to the provider.

Takeaway

Occupational therapy can help you get back to doing what you used to do every day (OT). This treatment is effective for various conditions, including arthritis, Parkinson’s disease, and dementia.

Medicare covers occupational therapy in the United States, where Medicare Part B covers outpatient OT while Medicare Part A covers inpatient OT. 

However, if you need help with premiums, deductibles, copayments, and coinsurance, you can always find a suitable Medicare Savings Program or just find a Medicare plan that suits your need.

Feel free to contact our licensed agents for any assistance in Medicare.