Mountain Views News, Sierra Madre Edition [Pasadena] Saturday, April 29, 2017

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Mountain Views-News Saturday, April 29, 2017 

HOW MEDICARE COVERS THERAPY SERVICES

SENIOR HAPPENINGS


Dear Savvy Senior,

Can you explain how Medicare covers physical therapy 
services? I’m a new beneficiary, and would like to get some 
treatments for my back. 

Need Help

 

Dear Need,

Medicare covers a variety of outpatient therapy services 
including physical, occupational and speech therapy, if 
you meet their coverage criteria. Here’s how it works.

 

Medicare Coverage 

To get Medicare (Part B) to help cover your physical 
therapy, it must be considered medically reasonable and 
necessary, and will need to be ordered or prescribed by 
your doctor. 

You can get these services as an outpatient at a number 
of places like a doctor’s or therapist’s office, rehabilitation 
facility, medical clinic or a hospital outpatient department. 

You also need to know that Medicare limits how much 
it pays for outpatient therapy services in one calendar 
year. These limits are called “therapy cap limits.” In 2017, 
Medicare will cover up to $1,980 for physical and speech 
therapy combined, and another $1,980 for occupational 
therapy. 

 But be aware that just like with other Medicare covered 
services, Medicare will pay 80 percent (up to $1,584) 
of your therapy costs, after you meet your $183 Part B 
deductible. You, or your Medicare supplemental plan (if 
you have one), will be responsible for the remaining 20 
percent until the cap limits are reached. After that, you’ll 
have to pay the full cost for the services.

Extra Therapy 

 If, however, you reach your cap limits and your doctor 
or therapist recommends that you continue with the 
treatment, you can ask your therapist for an exception so 
that Medicare will continue to pay for your therapy. The 
therapist must provide documentation that these services 
are medically necessary for you to continue. If Medicare 
denies the claim, you can appeal through the Medicare 
appeals process – see Medicare.gov/claims-and-appeals.

 If approved, Medicare has an exception threshold of 
$3,700 for physical and speech therapy combined, and 
$3,700 for occupational therapy. If your therapy cost 
exceeds these thresholds, Medicare will audit your case, 
which could lead to denial of further services.

No Coverage

 If you choose to get physical therapy on your own 
that’s not considered medically necessary or prescribed 
by your doctor, your therapist is required to give you a 
written document called an “Advance Beneficiary Notice 
of Noncoverage” (ABN). Medicare Part B will not pay for 
these services, but the ABN lets you decide whether to get 
them. 

 

Therapy at Home

 You should also know that Medicare covers home 
therapy services too if you are homebound and eligible 
to receive home health care from a Medicare-approved 
home healthcare agency. To learn more about this option, 
see the “Medicare and Home Health Care” online booklet 
at Medicare.gov/pubs/pdf/10969.pdf.

Medicare Advantage

 If you are enrolled in a Medicare Advantage plan (like 
an HMO or PPO), these plans must cover everything 
that’s included in original Medicare Part A and Part B 
coverage. But sometimes these plans cover more, with 
extra services or an expanded amount of coverage. To 
find out whether your plan provides extra coverage or 
requires different co-payments for physical therapy, you’ll 
need to contact the plan directly.

More Information

 If you have other questions, call Medicare at 800-633-
4227, or contact your State Health Insurance Assistance 
Program (SHIP), who provides free Medicare counseling 
in person or over the phone. To find a local SHIP 
counselor visit Shiptacenter.org, or call the eldercare 
locator at 800-677-1116. 

 Send your senior questions to: Savvy Senior, P.O. Box 
5443, Norman, OK 73070, or visit SavvySenior.org. Jim 
Miller is a contributor to the NBC Today show and author 
of “The Savvy Senior” book.

HAPPY BIRTHDAY! …April Birthdays*

Howard Rubin, Hattie Harris, Mary Harley, Bette White, Dorothy White, Doris 
Behrens, Freda Bernard, Beth Copti, Terri Cummings, Marilyn Diaz, Virginia 
Elliott, Elma Flores, Betty Jo Gregg, Barbara Lampman, Betty Mackie, Elizabeth 
Rassmusen, Maria Reyes, Marian DeMars, Anne Schryver, Chrisine Bachwansky, 
Colleen McKernan, Sandy Swanson, Hank Landsberg, Ken Anhalt, Shannon Vandevelde 

* To add your name to this distinguished list, please call the paper at 626.355.2737. 
YEAR of birth not required

...................................................................

ACTIVITIES: Unless listed differently, all activities are at the Hart 
Park House (Senior Center) 222 W. Sierra Madre Blvd., Sierra Madre

 

 

Hawaiian & Polynesian Dance Class: Every Tuesday morning from 10a.m. to 
11a.m. Join instructor Barbara Dempsey as she leads you in the art of Hula. 

Bingo: Every Tuesday beginning at 1:00p.m. Cards are only $0.25 each! Everyone is welcome to join. 
May be canceled if less than five people. 

Free Blood Pressure Testing: 2nd Tuesday of the month from 11a.m. to 12p.m. No appt. is necessary. 

Brain Games: Thursdays, 10:30a.m. to 11:30a.m., improve your memory and strengthen your 
brain. Activities facilitated by Senior Volunteers.

Free Legal Consultation: Wednesdays from 10:30a.m. to Noon. Attorney Lem Makupson is 
available for legal consultation. He specializes in Family Law, Wills, Trusts, Estates, and Injury. 
Appointments are required by calling 626-355-7394. 

Senior Club: Meets every Saturday at the Hart Park House Senior Center. Brown Bag Lunch at 
11:30a.m. 

Tax Assistance: Every Wednesday beginning on February 1st through April 12th from 1:00p.m. 
to 2:00p.m. - Don Brunner is available for income tax consultation. Appointments are required by 
calling 626-355-7394.

Chair Yoga: Mondays and Wednesdays from 11:00 to 11:45a.m. with Paul Hagen. 3rd Monday of each 
month, a variety of balance exercises are practiced. All ability levels are encouraged and welcomed! 

*A suggested donation of $5 at one of the classes is requested, but is not required.

Case Management: Case Management services are provided by the YWCA and provide assistance in 
a variety of areas. Appointments are required and can be scheduled by calling the Hart Park House 
Office at 626-355-7394.

Birthday Celebrations: Every 2nd Thursday of the month at the Hart Park House, share some free 
birthday cake provided by the Sierra Madre Civic Club.

Game Day: Every Thursday starting at 12:00p.m. Come join this group of Seniors in a poker game. 
Other games are offered to all. Please note time change. 

Free Strength Training Class: Every Friday from 12:45p.m. to 1:30p.m. with Lisa Brandley. This 
energetic class utilizes light weights for low impact resistance training. All class materials are provided.

Stress, Resilience, Positivity: Finding Balance - by The Kensington Sierra Madre Four Tuesdays, 
March 7 - 28th from 2:00 - 4:00p.m. Register by calling 213-821-6919 or 213-821-6908. 



SENIOR EXCURSIONS

 APRIL EXCURSION

APRIL EXCURSION - SAVE THE DATE

 Tanaka Farms Strawberry Tour (Irvine)

 Date: Thursday, April 27th

 Time: 9:30a.m. to 2:30p.m.

 Meeting Location: Hart Park House

 Cost: $20.00 (Not including Lunch)

 

Come experience a real working farm in the heart of Orange County. Tour includes a guided wagon 
ride around the 30-acre Farm. Learn about and sample different fruits and vegetables in season. Pick 
and eat fresh, juicy strawberries. You will be given a one-pound container to fill with berries. Things to 
consider:

- Wear comfortable shoes that you don’t mind getting dirty.

- The farm is not handicapped accessible; and wagon rides on dirt

roads will be bumpy.... and lots of bending to pick berries.

- Bring your sack lunch to eat at the picnic tables.

- Spending money is optional for market shopping.

Level of walking: Medium – High.

Please call the Hart Park House for reservations at 626-355-7394. 


Mountain Views News 80 W Sierra Madre Blvd. No. 327 Sierra Madre, Ca. 91024 Office: 626.355.2737 Fax: 626.609.3285 Email: editor@mtnviewsnews.com Website: www.mtnviewsnews.com