Does Medicare cover aquatic therapy?

Your doctor may recommend aquatic therapy if you have musculoskeletal, neuromuscular, cardiovascular, or other disorders. It is conducted in a (usually heated) therapy pool.

But does Medicare cover aquatic therapy? Will you have to pay any out-of-pocket costs for the sessions? We’ll answer these questions and more your Medicare health insurance coverage below.

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Does Medicare cover aquatic therapy?

Medicare Part B will cover aquatic therapy as a type of physical therapy as long as it is considered medically necessary.

Medicare Advantage plans must be the same as or better than original Medicare, so they will most likely cover aquatic therapy as well, but you should contact your policyholder for details.

What other physical therapies does Medicare cover?

Medicare Part B will cover any outpatient therapy services that are medically necessary. While Medicare used to limit the number of services you could receive, this is no longer the case. You can attend as many of these sessions as needed.

Medicare Advantage plans will also cover medically necessary outpatient physical therapies. Your plan provider will have more details regarding your specific policy.

You may seek out services from physical therapists, speech-language pathologists, and occupational therapists, as well as doctors and other healthcare providers who offer these services. However, the healthcare provider and their facility must accept Medicare.

You may still face out-of-pocket expenses, such as premiums, deductible ($203 as of 2021), and copayment or coinsurance. If you have a Medigap plan, you may be able to get help paying for these.

Case Study: Medicare Coverage Analysis of Aquatic Therapy for Rehabilitation and Pain Management

Case Study 1: John’s Recovery Journey

John is a 65-year-old retiree who recently underwent knee replacement surgery. His doctor recommends aquatic therapy as part of his rehabilitation program to improve joint mobility and strength.

John is enrolled in Medicare Part B, which covers outpatient services, including physical therapy. Aquatic therapy falls under this category. However, Medicare requires that the therapy is deemed medically necessary and provided by a qualified healthcare professional.

John’s physician submits a referral for aquatic therapy, stating the medical necessity due to John’s knee replacement surgery. The therapy sessions are conducted by a licensed physical therapist at an approved facility. Medicare covers a portion of the costs, and John pays the remaining deductible and coinsurance.

Through aquatic therapy, John experiences improved mobility and successfully recovers from his surgery.

Case Study 2: Sarah’s Arthritis Management

Sarah is a 72-year-old Medicare beneficiary diagnosed with rheumatoid arthritis. She experiences joint pain and stiffness, affecting her ability to perform daily activities. Sarah’s rheumatologist suggests aquatic therapy as a non-pharmacological treatment option to manage her symptoms.

Medicare Part B covers outpatient services, including physical therapy, if they are considered medically necessary. Aquatic therapy can be deemed medically necessary for individuals with conditions like arthritis, as it provides a low-impact environment that reduces stress on joints.

Sarah’s rheumatologist submits a referral for aquatic therapy, highlighting the medical necessity of the treatment for her arthritis management. The therapy sessions are conducted by a licensed physical therapist at an approved facility.

Medicare covers a portion of the costs, and Sarah is responsible for the deductible and coinsurance. Aquatic therapy helps Sarah alleviate pain, improve joint flexibility, and enhance her overall quality of life.

Case Study 3: Mark’s Non-Covered Aquatic Therapy

Mark is a 70-year-old Medicare beneficiary who suffers from chronic lower back pain. His chiropractor recommends aquatic therapy to alleviate his symptoms and improve his functional capacity.

Although aquatic therapy can be beneficial for certain conditions, Medicare’s coverage guidelines require that services be considered medically necessary. In Mark’s case, Medicare may consider aquatic therapy as a non-covered service if it does not meet the necessary criteria.

Mark’s chiropractor submits a referral for aquatic therapy, but it is deemed not medically necessary by Medicare. Consequently, Medicare does not cover the therapy costs. Mark decides to pay for the therapy sessions out of pocket, as he believes the potential benefits outweigh the expense.

Despite the lack of Medicare coverage, Mark finds relief from his back pain and experiences improved mobility through the aquatic therapy sessions.

The Bottom Line

Medicare Part B will cover outpatient aquatic therapy, along with other types of physical therapy as a continued treatment, as long as they are considered medically necessary. There are no longer any limits to how many sessions you can complete.

Medicare Advantage plans will also cover outpatient physical therapies, but you should contact your individual policyholder to ask for details.

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