Yes, in many cases, and you may not need to be homebound. Here is how Medicare coverage for therapy at home works and what to expect.
Getting to a clinic is not always easy. After surgery, a stroke, or a fall, or if you do not drive, therapy at home can make the difference between getting care and going without.
Many people with Medicare do not realize that physical therapy at home can be covered, and that you may not need to be homebound to get it. This guide explains how it works in New Jersey.
Two Ways Medicare Covers Therapy at Home
Medicare can pay for therapy in your home in two different ways. They have different rules.
1. Home health care
Home health care is provided by a Medicare-certified home health agency. To qualify, you must:
- Be considered homebound, meaning leaving home takes a major effort
- Need skilled care, such as nursing or therapy, on a part-time basis
- Have a doctor or other qualified provider certify your need for home health
Home health is often arranged at hospital discharge and usually includes nursing visits along with therapy.
2. Outpatient therapy in your home (Medicare Part B)
This is the type of care Holsman provides. A Medicare-enrolled therapy practice sends a licensed therapist to your home under your Medicare Part B outpatient therapy benefit.
- You do not need to be homebound.
- Therapy must be medically necessary, meaning you need a therapist's skill to improve, or to keep from getting worse.
- Your plan of care must be certified (signed) by your doctor, nurse practitioner, or physician assistant, and recertified over time.
You cannot get home health agency care and outpatient therapy at the same time. If you are finishing home health, outpatient therapy at home can be a good next step.
What Does It Cost?
Under Original Medicare Part B:
- You first meet the yearly Part B deductible.
- After that, you usually pay 20% of the Medicare-approved amount for each visit.
- A Medigap (Medicare Supplement) plan may cover some or all of that 20%.
Medicare no longer has a hard yearly limit on therapy. Above a yearly spending threshold, your therapist must confirm that continued therapy is medically necessary.
What About Medicare Advantage?
Medicare Advantage plans must cover the same basic benefits as Original Medicare, but they set their own rules. Many require you to use in-network providers, and many require prior authorization before therapy starts. Copays vary by plan.
Our staff will check your plan and handle any authorization requests before your first visit. See our insurance page for the plans we accept.
Do I Need a Referral?
In New Jersey, you can see a physical therapist without a prescription. For Medicare to pay, though, a physician, nurse practitioner, or physician assistant must certify your plan of care. Our team coordinates this with your doctor so you can focus on getting better.
Who Benefits From In-Home Therapy?
- People recovering from surgery, such as a knee replacement or hip replacement
- Stroke survivors and people with Parkinson's or other neurologic conditions
- Older adults with balance problems or recent falls (see our fall prevention program)
- People with arthritis, weakness, or pain that makes travel hard
- Anyone without reliable transportation
What In-Home Therapy Includes
Our licensed therapists bring the clinic to you. Depending on your needs, care can include:
- Physical therapy for strength, walking, balance, and pain
- Occupational therapy for dressing, bathing, and daily tasks
- Speech therapy for communication and swallowing
- A home safety check with practical changes to lower fall risk
- Training for family members and caregivers
Where We Provide In-Home Therapy
Holsman provides in-home therapy across Northern New Jersey, including Kearny, North Arlington, Lyndhurst and Rutherford, and near our clinics in Bloomfield, Clifton, Fair Lawn, Paterson and more. In New York, our sister company Home Therapy PT provides in-home therapy in Rockland County.
Call 1-855-465-7626 or contact us to check your coverage.
Frequently Asked Questions
Do I have to be homebound for Medicare to cover PT at home?
Not for outpatient therapy provided in your home under Medicare Part B. Homebound status is required only for home health agency care.
How much does in-home physical therapy cost with Medicare?
With Original Medicare, after your Part B deductible you usually pay 20% of the Medicare-approved amount per visit. A Medigap plan may cover that share. Medicare Advantage costs vary by plan.
Do I need a doctor's prescription for in-home PT?
New Jersey lets you see a physical therapist without a prescription, but Medicare requires your doctor, nurse practitioner, or physician assistant to certify your plan of care. We coordinate this with your doctor.
Can I get home health and outpatient PT at the same time?
No. Medicare does not cover both at once. Many people switch to outpatient therapy at home when home health care ends.
Does Medicare Advantage cover in-home therapy?
Usually, but rules vary. Many plans require in-network providers and prior authorization. Our staff will check your plan before your first visit.
This article is for general education and isn't a substitute for an evaluation by a licensed clinician.