How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?

Question

Robert Vaughan, R.Ph., MBA · Accepted Answer

Medicare Part B covers occupational therapy as long as it is considered to be medically necessary and your provider recommends it. There are no limits to the number of occupational therapy sessions Medicare will cover, but you will pay 20% of the Medicare-approved rate after you have met your Part B deducible.

If you are an inpatient in a hospital or skilled nursing facility, occupational therapy is covered under Medicare Part A.

Larry Dalton · Answer

Yes, when medically necessary and prescribed by your physician, there are no limits on the number of visits. You will be expected to pick up 20% of the charges without a Medicare supplement or Medigap plan. Medicare Advantage plans will do likewise, and in some cases, they may offer additional benefits, but most likely, there will be extra cost-sharing involved in the treatments. Some Medicare Advantage plans may require prior approval before treatments.

Answered by Larry Dalton on May 5, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Gary Church · Answer

Medicare will usually cover it if it's medically necessary.  Medicare says if your doctor indicates that it is medically necessary.

Misty Bolt · Answer

Medicare Part B can cover medically necessary outpatient occupational therapy for arthritis or mobility issues if a doctor certifies the need for it. There is no limit to how much Medicare will pay for medically necessary occupational therapy in a calendar year.

Answered by Misty Bolt on May 10, 2025

Agent Licensed in TN, AL, AR & 45 other states

Answered by Misty Bolt Medicare Insurance Agent

Ben Washington · Answer

How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits? by using your part b outpatient services. There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.

Answered by Ben Washington on May 6, 2025

Broker Licensed in IL, FL, MN, SC, TX & WI

Answered by Ben Washington Medicare Insurance Agent

Leslie Kaz · Answer

Medicare can cover occupational therapy (OT) for arthritis or mobility issues, but coverage depends on the type of Medicare plan you have, the setting of the therapy, and specific requirements.

Eduardo Camacho · Answer

Medicare will only pay for Therapy if it is deemed Medically necessary, to get Medicare to cover occupational therapy it will be necessary to get a doctor to certify that Occupational Therapy is necessary and to recommend a treatment plan.

Answered by Eduardo Camacho on May 5, 2025

Agent Licensed in CA, FL, NC, NV, SC & TX

Answered by Eduardo Camacho Medicare Insurance Agent

Carlos Pratts · Answer

Medically Necessary: The therapy must be considered medically necessary for the treatment of your condition, such as arthritis, and not merely for general fitness or maintenance.

No Limits: There are no limits on the number of occupational therapy sessions Medicare will cover annually, provided that the therapy is deemed medically necessary.

Fred Manas · Answer

Here's a detailed breakdown:
Medically Necessary:
Medicare will only cover occupational therapy if it's considered medically necessary to help you improve or maintain your ability to perform activities of daily living. 
Doctor's Certification:
You'll need a doctor or other healthcare provider to certify that you need occupational therapy and to develop a treatment plan. 
Outpatient Setting:
The therapy must be provided in an outpatient setting, like a clinic or therapy center, and not as an inpatient service. 
Provider Acceptance:
The occupational therapy provider must accept Medicare assignment, which means they agree to bill Medicare directly and accept the Medicare-approved amount as payment in full. 
Deductible and Coinsurance:
You'll need to pay your Part B deductible before Medicare starts paying, and then you'll pay 20% of the Medicare-approved amount for each session. 
No Limits:
There is no limit on how many sessions or how much Medicare will pay for medically necessary occupational therapy in a calendar year. 
Annual Threshold:
In 2025, Original Medicare covers up to $2,410 for combined physical therapy and speech-language pathology (SLP) services, and $2,410 for OT alone. However, there is no limit on the amount Medicare pays for medically necessary services.

Douglas Carney · Answer

Medicare Part B covers occupational therapy as long as it is considered to be medically necessary and your provider recommends it. There are no limits to the number of occupational therapy sessions Medicare will cover, but you will pay 20% of the Medicare-approved rate after you have met your Part B deducible.

If you are an inpatient in a hospital or skilled nursing facility, occupational therapy is covered under Medicare Part A.

Answered by Robert Vaughan, R.Ph., MBA on May 6, 2025

Broker Licensed in CA, AZ, NM, NV & TX

Answered by Robert Vaughan, R.Ph., MBA Medicare Insurance Agent

Tonya Mowan · Answer

To qualify or OT an individual would need a referral from the doctor with a care plan. Medicare Part B helps cover OT when medically necessary. Understand that there may be out of pocket cost depending on your plan coverage such as the Part B deductible for the year and copays. This is where you need to talk to your plan carrier or agent to help you understand the coverage.

Answered by Tonya Mowan on May 12, 2025

Agent Licensed in AR

Answered by Tonya Mowan Medicare Insurance Agent

Joseph Lombardo · Answer

Medicare does cover occupational therapy for arthritis or mobility issues, generally in its part B category. Keep in mind, this all has to be medically necessary and approved by your physician. I hope this helps.

Answered by Joseph Lombardo on May 5, 2025

Agent Licensed in NY, CT, NJ & PA

Answered by Joseph Lombardo Medicare Insurance Agent

How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?

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How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?

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