With the length of hospital stays continuing to decline for patients following an illness or surgery, more and more people are utilizing outpatient therapy. For older adults and those living with a disability that qualifies them to receive Medicare benefits, the outpatient therapy caps are often confusing, and rightly so.
The caps have been changed, modified, and exempted during almost every Congressional budget season for the past decade. We’ve pulled together a 2014 update to help caregivers in Illinois and Missouri better understand what outpatient therapy services their loved one is entitled to receive and how much it might cost.
2014 Medicare Part B Therapy Cap Update
According to the most recent Medicare therapy cap update from January of 2014, here is what you need to know:
1. The 2014 cap for physical and speech therapy combined is $1,920.
2. The occupational therapy cap for 2014 is also $1,920.
3. Medicare recipients are liable for 20% of the outpatient therapy services and for meeting the $147 Part B deductible.
4. Outpatient therapy services can be provided in private therapy office, medical offices, outpatient department of a hospital, outpatient rehab facilities, comprehensive outpatient rehab facilities (CORF), skilled nursing facilities for residents/outpatients not already receiving Medicare skilled benefits, and through some certified home health agencies.
5. There are exceptions to the outpatient therapy caps. Your therapist can help you apply for an exemption if you can prove it is medically reasonable and necessary.
6. Your therapist must provide you with an Advance Beneficiary Notice of Noncoverage (ABN) if you need services that aren’t considered medically necessary. Since Medicare does not cover services that aren’t considered medically necessary, this document will allow you to decide whether or not you want to receive the additional therapy at your own expense.
7. You can track how close you are to the therapy cap by visiting MyMedicare.gov or by reviewing your account with your treating therapist.
To learn more visit your State Health Insurance Program (SHIP) or call Medicare directly at 1-800-633-4227.