Here’s the Good News: If You Have Medicare or Insurance, Your In‑Home PT May Be Covered

The biggest obstacle to starting physical therapy shouldn’t be cost or confusion about coverage. That’s why we make it simple: we verify your benefits upfront, handle all the paperwork, and explain exactly what you’ll pay — no surprises, no hidden bills, no stress.

If you’re worried that in-home therapy is too expensive or unsure if your insurance covers it, this page answers all those questions.

Quick Answer: Will Your Insurance Cover In‑Home Physical Therapy?

Insurance Type	Covered?	What You Pay
Medicare (Original)	✅ Yes	$257 deductible/year + 20% coinsurance
Medicare Advantage	✅ Usually Yes	Varies by plan (often $0 copay)
Private Insurance (PPO/HMO)	✅ Often Yes	Depends on plan; we’ll verify
No Insurance	✅ Self-Pay Available	Affordable self-pay rates available

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The bottom line: Most of our patients are covered. And if you’re not sure, that’s exactly what our free coverage check call is for.

Let’s Check Your Coverage Together — No Pressure, Just Clarity

How Medicare Covers In‑Home Physical Therapy

If you have Medicare, here’s what you need to know:

Medicare Part B Covers In‑Home PT

What’s covered:

• Licensed physical therapist evaluation in your home
• Treatment sessions (exercises, mobility training, pain management)
• Regular progress assessments
• Home safety recommendations
• No requirement to visit a clinic first

How much Medicare pays:

• Medicare pays 80% of the approved amount for your therapy
• You pay 20% (coinsurance) after you meet your annual deductible

The Numbers (2025)

Your annual deductible: $257 (one-time per year)

Once you’ve paid $257, Medicare covers 80% of the remaining therapy costs.

Example:

• Therapy session cost: $160
• Medicare pays: $128 (80%)
• You pay: $32 (20%)

For 20 sessions over 3 months:

• Total cost: $3,200
• Your deductible: $257
• Your remaining coinsurance (20% of $2,943): ~$589
• Your total out-of-pocket: ~$846

Important: There’s No Hard Cap on Sessions

You may have heard about Medicare’s “therapy cap.” Here’s the truth: There is no hard limit on how many sessions you can receive.

What exists is a therapy threshold — an annual monitoring point where Medicare asks your provider to document that therapy remains medically necessary. If it does (which it usually does when prescribed by your doctor), Medicare continues covering your sessions.

You don’t stop getting therapy when you hit a threshold number. You continue getting covered care.

We Handle All the Medicare Paperwork

You don’t need to:

• Call Medicare to verify benefits
• Fill out forms or submit claims
• Worry about coding or authorizations
• Understand the insurance jargon

We do all of that. We:

• Verify your Medicare coverage before your first visit
• Bill Medicare directly (you never deal with the claim)
• Explain your costs upfront, in plain English
• Handle any denials or coverage questions

What About Medicare Advantage Plans?

If you have Medicare Advantage (Part C), coverage is at least equal to Original Medicare — but often better.

Coverage Varies by Plan

Some Medicare Advantage plans offer:

• $0 copayment for in-home PT
• $15-50 per session copayment
• Covered in-full with proper authorization

The catch: Every plan is different.

Here’s What We Do

Before your first visit, we:

• Call your Medicare Advantage plan directly
• Verify your exact coverage and copayment
• Confirm pre-authorization requirements
• Give you a clear cost estimate

You’ll know exactly what to expect before therapy starts.

What About Private Insurance (PPO, HMO)?

Many private insurance plans cover in-home physical therapy — but coverage varies widely.

Typical Private Insurance Coverage

Plan Type	In-Home PT Covered?	Typical Cost	Requirements
PPO	Often Yes	$0–$50 copay or percentage coinsurance	May need referral from MD
HMO	Often Yes	$0–$50 copay	Typically need referral from PCP
TRICARE (Military)	Yes	Varies by branch	May need authorization
VA Benefits	Yes (if eligible)	Often $0	Requires VA eligibility

We Verify Your Coverage

Every private plan is different. Here’s our process:

1. You provide your insurance card
2. We call your insurance company directly
3. We confirm: Coverage, copayment, referral requirements, and pre-authorization
4. We explain it to you in plain English
5. You start therapy knowing exactly what you’ll pay

Cost Comparison: In‑Home PT vs. Clinic-Based PT

Here’s what most people don’t realize: In-home PT often costs less than clinic-based care — even with insurance.

Why In-Home Can Be More Affordable

Cost Factor	Clinic PT	In-Home PT
Session Cost	$150–$200	$150–$200 (same)
Travel Time	30–90 min + transportation	None
Missed Appointments	Higher (transportation barriers)	Lower (no barriers)
Total Sessions Needed	Often more (due to missed appts)	Often fewer (higher compliance)
Facility Fees	Included in cost	Not applicable
Your Out-of-Pocket	20% copay × more sessions	20% copay × fewer sessions

Real-World Example

Clinic PT:

• Patient books 24 sessions over 8 weeks
• Misses 4 sessions due to transportation (doctor, weather, family emergencies)
• Completes 20 sessions
• Recovery extended 4 weeks due to missed therapy
• Total out-of-pocket: ~$800 (20% × 20 sessions)

In-Home PT:

• Patient books 20 sessions over 6 weeks
• Misses 0 sessions (no transportation barrier)
• Completes 20 sessions
• Recovery finished 4 weeks earlier
• Total out-of-pocket: ~$640 (20% × 20 sessions)
• Saves: $160 + 4 weeks of faster recovery

Plus: You save time, effort, and stress. No traffic, no waiting rooms, no coordination burden for the family.

Self-Pay Option (If You Don’t Have Insurance)

Not all patients have insurance. That’s okay. We work with self-pay patients.

Self-Pay Rates

Typical cost: $125–$200 per session (depending on therapist and complexity)

Comparison:

• Medicare: $32–$40 per session (after deductible)
• Self-pay: $125–$200 per session

If cost is a barrier: Talk to us. We may be able to work with you on pricing, payment plans, or connect you with resources.

Medicare Frequently Asked Questions

“Do I Need a Doctor’s Referral?”

In California: No. You can self-refer to physical therapy (direct access). A therapist can evaluate and treat you without a doctor’s order.

However: Medicare requires medical certification that therapy is medically necessary. Your therapist can coordinate with your doctor to ensure proper documentation.

Bottom line: You can call us today and start the process — no doctor’s paperwork required upfront.

“What If I Haven’t Met My Deductible Yet?”

You’ll pay your deductible first (up to $257 in 2025). After that, Medicare covers 80% and you pay 20% coinsurance.

We’ll tell you upfront: “Your deductible is $257. Your first few sessions will go toward that. Once it’s met, you’ll pay 20% per session.”

“Does Medicare Cover a Home Safety Evaluation?”

Yes. If your therapist determines that a home safety assessment is medically necessary, Medicare covers it as part of your treatment plan.

“What If I Have Both Medicare and a Medigap or Supplemental Plan?”

Great news: Your supplemental plan (Medigap) may cover your 20% coinsurance.

What happens:

1. Medicare pays 80%
2. Your Medigap plan pays some or all of the remaining 20%
3. You may pay $0

Check your Medigap policy — many cover coinsurance fully.

“Do I Have to Choose Between PT and Occupational Therapy?”

No. Medicare covers both separately. You can receive PT for strength and balance, and OT for daily living skills — at the same time, with coordinated treatment.

“What If I Have Secondary Insurance (TRICARE, VA, etc.)?”

We work with TRICARE, VA benefits, and other secondary insurance. Benefits are coordinated, and we handle all the billing.

Let us know if you have secondary coverage, and we’ll verify how both plans coordinate.

“What Happens If Medicare Denies My Claim?”

This is rare when therapy is medically necessary and properly documented. But if it happens:

1. We review the denial with you
2. We appeal on your behalf if appropriate
3. We work with your doctor to provide medical justification
4. We explain your options

You’re not alone in this process. We handle it.

Private Insurance: Common Questions

“Do I Need a Referral from My Doctor?”

Depends on your plan:

• PPO plans: Usually no (check your plan)
• HMO plans: Usually yes (contact your primary care doctor)

We’ll tell you: When we verify your coverage, we’ll let you know if a referral is needed.

“How Long Does Pre-Authorization Take?”

Usually 2-5 business days. We handle the request — you don’t have to.

“What If My Plan Denies In-Home PT?”

Some plans require “medical necessity” documentation or prefer clinic-based care. If that happens:

1. We explain why in-home care is appropriate for your situation
2. We submit supporting documentation from your doctor
3. We request a peer-to-peer review (doctor-to-doctor conversation)
4. We explore alternative options if needed

Real Patient: Insurance Coverage Story

“I was so worried about cost. My daughter found Care To You Health, and they said they’d check my Medicare coverage. They called my insurance company, explained everything to me in plain English, and told me exactly what I’d pay. Turns out, Medicare covered most of it. I paid about $600 total for three months of therapy. I was shocked at how affordable it was — and how stress-free they made the whole thing.”

— Martha, 78, Orange County

Here’s How We Make Insurance Easy

Step 1: Tell Us What You Have

“I have Medicare.” “I have Blue Shield.” “I’m not sure.” — Whatever you say, we work with it.

Step 2: We Verify Your Coverage

We call your insurance company directly. We get:

• Whether in-home PT is covered
• Your deductible status
• Your copayment or coinsurance
• Any pre-authorization requirements

Step 3: We Explain It Clearly

No insurance jargon. No confusing letters. We tell you:

• “Your deductible is $257. You’ll pay that first.”
• “After that, Medicare covers 80%, and you pay 20% — about $30 per session.”
• “You’ll owe roughly $600 total for 20 sessions.”

Step 4: We Bill Everything

You focus on recovery. We:

• Bill your insurance directly
• Handle all paperwork
• Follow up if there are any questions
• Send you a simple, clear statement of what you owe

Step 5: No Surprises

You’ll never get an unexpected bill. You’ll never wonder what you’re paying for.

Cost Summary: What to Expect

Medicare Patient (20 Sessions)

• Deductible: $257 (paid once per year)
• Sessions: 20 × $160 = $3,200
• Medicare pays: 80% = $2,560
• You pay: 20% = $640
• Your total out-of-pocket: ~$897

Medicare Advantage Patient (20 Sessions)

• Plan variation: $0–$50 per session copay
• If $0 copay: You pay $0
• If $25 copay: 20 × $25 = You pay $500

Private Insurance Patient (20 Sessions)

• Depends on the plan
• Typically: $0–$50 copay or 20% coinsurance
• Could be: $0–$600 depending on your plan

Don’t Let Cost Concerns Delay Recovery

The worst thing you can do is avoid therapy because you’re worried about cost. The longer you wait, the worse the decline becomes. And decline is expensive — in hospital bills, emergency visits, and lost independence.

Early intervention with therapy is an investment in your independence and health.

Ready to Check Your Coverage?

Option 1: Call Now for a Free Coverage Check

No appointment needed. Just call. We’ll:

• Ask a few quick questions about your insurance
• Call your insurance company
• Explain your coverage and costs
• Answer all your questions

Connect Via Phone: 949-353-5509

Option 2: Schedule a Free Consultation

Talk to a licensed physical therapist. Ask anything about insurance, costs, or what therapy might do for you.

Schedule Your Free Consultation

Option 3: Download Our Insurance Guide

Get a printable guide explaining Medicare coverage, private insurance options, and what to expect cost-wise.

The Bottom Line

Your insurance situation should not prevent you from getting the therapy you need.

We work with Medicare, Medicare Advantage, private insurance, TRICARE, VA benefits, and self-pay patients. We verify coverage upfront. We explain costs clearly. We handle all the paperwork. And we never hit you with surprise bills.

You deserve transparency, clarity, and the support you need to heal.

Additional Resources

• [Blog: Medicare Coverage of In-Home Physical Therapy]
• [Blog: In-Home PT vs. Clinic-Based Care: Which Costs Less?]
• [Services Overview]
• [Patient Testimonials]

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You Deserve Answers, Not Surprise Bills

We’ll walk you through it, like family would.

📞 (949) 353-5509

Check Your Coverage Now — Free, No Pressure

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Care To You Health

100% Mobile. Medicare-Designated. Orange County-Based.

Your recovery shouldn’t be delayed by insurance confusion. Let’s make it simple.