Does Medicare Cover Occupational Therapy?
Some people need occupational therapy after an injury, surgery, or stroke. The service may also be helpful for people with Alzheimer’s and other forms of dementia. Medicare covers as many sessions of occupational therapy as you need—as long as they’re medically necessary. In this blog, we’ll discuss how Medicare covers the services and how much your out-of-pocket costs may be.
Key takeaways:
Medicare covers occupational therapy if it’s medically necessary and your doctor recommends the services.
There is no limit on how many occupational therapy sessions Medicare will cover.
You’ll pay 20% of the cost of each session after you pay your Part B deductible. A Medicare Supplement plan can help pay for some of these costs.
Medicare covers occupational therapy in outpatient settings and as part of home health care and hospice services.
What is occupational therapy?
The goal of occupational therapy is to help people enhance their quality of life and achieve independence. It’s is a form of healthcare that focuses on improving a patient’s ability to perform daily tasks like:
Self-care activities like bathing, grooming, dressing, and eating
Medication management
Household chores like dishes, laundry, and home maintenance
Tactile activities like writing and drawing
Driving or using public transportation
Engaging in hobbies and social activities
Exercise and maintaining physical activity
Occupational therapists work with people to develop a plan of care tailored to their specific needs. For example, if a senior needed occupational therapy to regain mobility and fine motor skills after an injury, a therapist would focus on that specific goal. Occupational therapy can involve other methods for holistic treatment like:
Cognitive-behavioral counseling
Using medical equipment and assistive technology
Modifying the environment for specific purposes
Education and training for patients and caregivers
You can receive occupational therapy services in various settings, including hospitals, outpatient clinics, mental health facilities, and at home.
Does Medicare cover occupational therapy?
If you’re wondering if Medicare covers occupational therapy, it absolutely does! Medicare Part B covers any occupational therapy services if they’re medically necessary and a healthcare provider recommends that you need them.
The other good thing is that there’s no limit to the number of occupational therapy sessions you can get in one calendar year. Medicare pays for the services as long as your doctor certifies you need occupational therapy.
Occupational therapy is also included in your Medicare coverage if you’re receiving home health care or hospice care services.
How much do you pay for occupational therapy on Medicare?
Like most other medical services, you’ll pay 20% of the cost of occupational therapy sessions after you meet your Part B deductible. You can reduce your out-of-pocket costs for occupational therapy and other services with a Medicare Supplement plan. These plans help cover the 20% of costs that Original Medicare doesn’t.
If you had Medicare Supplement Plan G, for instance, you’d pay nothing for occupational therapy sessions after you meet your Part B deductible (which is $240 in 2024).
What other related services does Medicare cover?
In some cases, people who need occupational therapy could also benefit from other rehabilitation or care services. Medicare also covers the following related benefits:
Speech-language pathology
Mental health services including counseling, medication, and preventive screenings
Home health care
Short-term stays at a skilled nursing facility
If you need help using your Medicare coverage or want to learn about your Medicare coverage options, our licensed Medicare Advisors are here for you. You can reach us by phone at 855-900-2427 or schedule a time to chat.