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Does Medicare Cover Occupational Therapy?

An injury, illness, or disability can not only create health concerns for you, but also interfere with your life, whether that’s forcing you to stop working or even inhibiting day-to-day activities. Attempting to return to your normal life or at least mitigate these effects are a critical part of any treatment plan. The recovery process may be a long one, but there are ways you can return at least some of your ability to work or do daily chores. One of these methods is called occupational therapy, and it can be a powerful tool to help you regain your life after or during recovery.

What is Occupational Therapy?

Occupational therapy is a bit of a broad term for the number of ways it can help you to regain your ability to do daily tasks, whether that’s feeding yourself or going to work. This type of therapy looks at the needs of the patient and how they’re inhibited and comes up with ways to help them overcome that problem. This can be a useful service for people of any age. Throughout occupational therapy, you may learn to adapt to your new circumstances or regain old skills that were impacted by the health circumstances that required the occupational therapy. The methods used by an occupational therapist can range from teaching you to use tools to help with specific functions to working on physical attributes like strength or balance. How the occupational therapist proceeds ultimately is based on the specific needs of the patient.

Occupational therapy focuses on the outcome, getting you to complete tasks with whatever tools are needed.

This may sound similar to a physical therapist, but, while there may be some overlap, the two professions differ in a few key ways. The primary difference is focus. Occupational therapy focuses on the outcome, getting you to complete tasks with whatever tools are needed, while physical therapy is more about the process, strengthening and conditioning your body so that you can manage pain and regain function.

Medicare Coverage of Occupational Therapy

Of course, occupational therapy isn’t free, and it can get expensive without coverage. If you’re enrolled in Medicare, you’re in luck, because this useful therapy is often covered by Medicare, as long as it’s deemed medically necessary by your doctor.

Outpatient Occupational Therapy

Many people will receive occupational therapy in an outpatient setting. If you’re among them, this means you’ll likely receive Medicare coverage through Medicare Part B. As with any service covered under Medicare Part B, before your coverage kicks in, you’ll need to hit your annual Part B deductible. In 2022, this deductible is $233. Once you’ve hit that deductible, Medicare will cover 80 percent of the approved cost for the occupational therapy, with you owing the remaining 20 percent.

There is no limit to how many occupational therapy appointments you have or how much Medicare pays for these services, as long as they’re medically necessary.

Appointments typically cost between $50 and $400, depending on the services used and the type of appointment you’re having. This means that you may owe between $10 and $80, depending on where you go and the type of service you use. Some occupational therapists may have you use durable medical equipment, which should be covered by Medicare as well. Unlike some services covered under Medicare Part B, there is no limit to how many occupational therapy appointments you have or how much Medicare pays for these services as long, as they’re medically necessary.

Occupational Therapy as Part of Inpatient Care

If you’re receiving occupational therapy as part of inpatient care, you won’t be covered by Medicare Part B. Instead, it’s Part A that will cover these services. Like Part B, Medicare Part A has a deductible, which is $1,556 in 2022. Once you’ve reached that with Part A covered costs, your coverage begins. Occupational therapy through inpatient care will be covered under your Part A hospital coinsurance. For days 1 through 60, you have a $0 coinsurance. After that, you’ll have a daily coinsurance that changes each year. For days 61 through 90, you’ll owe $389 each day in 2022. After that, you’ll fall into lifetime reserve days, which have a daily coinsurance of $778 in 2022.

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Occupational therapy can be a powerful option for people simply looking to protect their quality of life, and possibly improve it. By working with an occupational therapist, you can develop a strategy to help you regain some function or abilities affected by an illness, injury, or disability. And with your Medicare coverage, you can have affordable access to this therapy if you need it!

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