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Physical therapist guiding patient through balance and mobility rehab
By Proactive Physical Therapy Medicare, Physical Therapy , , , , ,

Medicare and You: What’s Actually Covered for Rehab and Therapy?

Demystifying Medicare benefits for physical therapy, orthotics, and more – so you don’t miss out

If you’re a Medicare beneficiary – or caring for someone who is – you may wonder what’s really included when it comes to rehab, recovery, and therapy services. With confusing terms, changing policies, and long wait times, it’s easy to miss out on benefits you’re entitled to.

At SV Proactive, we often hear questions like, “Does Medicare cover physical therapy?” or “Can I get custom orthotics for feet through Medicare?” The answer depends on the service, your diagnosis, and where you go.

Here’s what you need to know to make confident, informed decisions about your recovery – especially if you’re searching for Medicare-approved physical therapy clinics near me or senior rehab services covered by Medicare.

Does Medicare Cover Physical Therapy Services?

Yes – Medicare Part B covers medically necessary outpatient physical therapy services when prescribed by a doctor or healthcare provider. This includes:

  • Injury rehabilitation
  • Post-surgical recovery
  • Mobility and balance training
  • Strengthening for chronic conditions (e.g., arthritis, Parkinson’s)
  • Fall prevention and posture correction

Services must be provided by licensed physical therapists or assistants working under supervision in a Medicare-certified clinic.

💡 Important: Medicare typically covers 80% of the approved amount. You or your supplemental insurance may be responsible for the remaining 20%.

What About Custom Orthotics?

Custom orthotics – devices designed to support and correct foot alignment – can play a vital role in relieving pain, improving mobility, and preventing injury. Unfortunately, Medicare does not generally cover custom orthotics for feet unless:

  • They’re part of a Medicare-approved diabetic shoe insert program, or
  • You’ve had a qualifying lower limb injury or surgery and need them post-recovery

That said, many patients still opt to pay privately for custom orthotics near me because of the significant long-term benefits they provide in relieving foot, knee, or back pain.

How Many Therapy Sessions Will Medicare Cover?

Senior receiving Medicare-approved physical therapy in Sunnyvale clinic

Medicare no longer has a hard cap on physical therapy sessions, but it monitors usage closely. After you reach a certain dollar threshold (around $2,000–$2,500 annually), your therapist must certify that your treatment is:

  • Medically necessary, and
  • Leading to functional improvement

So yes – continued coverage is possible, but the focus must be on measurable progress.

Senior Therapy Services Covered by Medicare

Medicare covers a wide range of rehab services that support aging adults, including:

  • Post-joint replacement therapy (hips, knees, shoulders)
  • Stroke rehabilitation
  • Fall risk assessments
  • Balance and gait training
  • Pain management for chronic conditions
  • Incontinence therapy and pelvic floor support
  • Arthritis or osteoporosis-related rehab

These services can be performed in outpatient clinics, hospitals, skilled nursing facilities, or even at home—depending on your plan and need.

Choosing a Medicare-Approved Clinic: What to Look For

When searching for Medicare rehab coverage near me, here’s what to consider:

  • Is the clinic Medicare-certified for outpatient rehab?
  • Are sessions conducted by licensed physical therapists?
  • Does the clinic offer individualized plans rather than rushed, insurance-limited sessions?
  • Do they help with paperwork and documentation for Medicare claims?

At SV Proactive, we’re committed to helping patients navigate their Medicare benefits with ease—while providing world-class care that goes beyond the minimum standard.

Can I Still Use Private Pay If I Have Medicare?

Yes. Some patients choose to pay privately for additional services not covered by Medicare—like extended one-on-one sessions, wellness visits, or custom orthotics for foot pain. You can also use HSA/FSA funds if available.

Private pay allows greater flexibility and personalization, and you can combine both approaches for the best results.

You Deserve to Get the Most from Medicare

Navigating Medicare shouldn’t be a barrier to your wellness. Whether you’re recovering from surgery, managing chronic pain, or simply want to move better and feel stronger, SV Proactive’s team of top physical therapists is here to help.

Looking for trusted Medicare-approved physical therapy clinics near Sunnyvale? We’ll walk you through your coverage, create a plan that fits, and support you every step of the way.