Medicare vs Medicare Advantage plans for physical therapy: which one is right for you?

Medicare Health Insurance


With 2019 approaching quicker than we all want, it’s a good time to start thinking about your health plans.  If you are Medicare age, you may have a difficult time deciding to go with either a regular Medicare plan with a supplemental or one of the many Medicare Advantage plans.

The Medicare Advantage plans are privately run insurance programs that are subsidized by Medicare and run like a private plan with a very different set of benefits.

I can’t speak to the other benefits that are available for these plans, but there are some significant differences when it comes to physical therapy services and

benefits.  Since these is run like a private plan, the most common complaint from our clients is that they have a copay, sometimes ranging from $40-50.

With some of the Medicare Advantage plans, there may be a third party administrators that will limit the number of available physical therapy visits.  Medicare, on the other hand,  there is no limit on the number of visits available, assuming you meet medical necessity and your plan of care is signed by your physician.

Below is a quick chart that describes the differences:


Medicare Advantage

Covers 80% of charges

Requires a copay, most common is $40 per visit and sometimes requires additional authorization

If you purchase a supplemental plan, this covers the remaining 20% of PT cost.

20% of a typical PT visits for Medicare is about $14 per visit

Does not require supplemental plan

No limit on visits if you meet criteria for care and physician signs off on plan of care

May have limit in number of visits available.

If you are anticipating the need for physical therapy services in 2019, these are important details to consider.  Please call of our office at 303-665-2405 if you have any additional questions regarding the difference between these two types of plans.
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