Under Original Medicare in 2026, you pay the first $283 of Part B approved charges for the year (the deductible), then 20% of the Medicare-approved amount for each outpatient physical therapy visit, with Medicare paying the other 80%. A Medigap policy or other secondary coverage often pays some or all of that 20%. On a Medicare Advantage plan you usually pay a set copay per visit instead. The therapist’s office can tell you the approved amount for the visits you are likely to have.
Last reviewed By the Monon Therapy Collective editorial team
How do the Part B deductible and 20% coinsurance apply to therapy?
Outpatient physical therapy is covered under Medicare Part B, so the Part B deductible applies first. CMS set the 2026 Part B deductible at $283; once your approved Part B charges for the year pass that amount, from any doctor or outpatient service, you pay 20% of the Medicare-approved amount for each therapy visit.
The approved amount is set by Medicare’s fee schedule for each service code, not by the practice, and it varies a little by region. If you saw your doctor and had lab work earlier in the year, your deductible may already be met before therapy starts. The monthly Part B premium, $202.90 for most people in 2026, is separate and does not count toward the deductible.
Medicare has no limit on how much it pays for medically necessary outpatient therapy in a year, so the 20% keeps applying for as long as your therapy continues. Original Medicare also has no yearly out-of-pocket maximum, which is why a long course of therapy without supplemental coverage can add up, and why many people pair Medicare with a Medigap policy.
Does a Medigap policy pay the 20% for physical therapy?
Usually, yes. Most standardized Medigap plans pay the Part B coinsurance in full, so many people with a supplement pay little or nothing per therapy visit once the deductible is met. Plans K and L pay only part of it, and Plan N can involve small copays for some office visits.
Coverage of the Part B deductible itself is more limited: plans that cover it are not sold to people who became eligible for Medicare on or after January 1, 2020. Check your plan letter before therapy starts. The Medigap physical therapy coverage page explains each plan’s role, and Medicare Savings Programs run through Indiana Medicaid can pay Medicare cost sharing for people with limited income who qualify.
Why does it matter whether the therapist accepts Medicare assignment?
A therapist who accepts assignment agrees to take the Medicare-approved amount as full payment, so you owe only the deductible and the 20% coinsurance. A provider who does not accept assignment can charge more, though in many cases no more than 15% above the approved amount, and you may have to pay up front and wait for Medicare to reimburse you.
Ask any practice directly whether it accepts assignment for physical therapy. Before you book, the matching team checks which therapists in the network work with Medicare, and the therapist’s office confirms your benefits before the first visit. The cost and insurance page explains how that check works.
What do Medicare Advantage plans charge for a therapy visit?
Medicare Advantage plans replace the 20% coinsurance with their own cost sharing, most often a flat copay per therapy visit, and they cap yearly in-network spending with an out-of-pocket maximum that Original Medicare lacks. Copays, deductibles and network rules differ from plan to plan, so the evidence of coverage document for your specific plan is the only reliable source.
Many Advantage plans also require prior authorization for outpatient therapy and approve visits in blocks. Ask how each block is approved and how long approval usually takes. The Medicare Advantage physical therapy page lists what to ask, and the answer on Medicare visit limits covers the KX threshold that applies under Original Medicare.
How can you estimate your total cost for a course of therapy?
Multiply the number of visits your therapist expects by the approved amount per visit, take 20% of that, and add whatever is left of your Part B deductible; then subtract anything a Medigap or secondary plan pays. The therapist’s office can give you the approved amounts for an evaluation and a typical follow-up visit, which makes the arithmetic straightforward.
Your therapist estimates the number of visits after the evaluation and writes it into the plan of care that your physician certifies. For a person working on balance and fall prevention or recovering from a joint replacement, ask for that estimate at the first visit. To start, the physical therapy questionnaire takes two minutes, and you can call (888) 353-9975 if you prefer to talk it through.
- Remaining Part B deductible for the year
- Plus 20% of the approved amount for each expected visit
- Minus what a Medigap or secondary plan pays
- Plus nothing for the Part B premium, which you pay regardless of therapy
Related questions
Does Medicare pay for a physical therapy evaluation?
Yes. The evaluation is covered under Part B like other outpatient therapy, subject to the deductible and 20% coinsurance, and it is the visit where your plan of care is written.
Is there a copay for Medicare physical therapy?
Original Medicare uses 20% coinsurance rather than a flat copay. Medicare Advantage plans usually charge a copay per visit instead.
Can a therapist waive my Medicare coinsurance?
Routinely waiving coinsurance for Medicare patients is generally not allowed under federal rules. Practices can reduce amounts for documented financial hardship, case by case.
Does Medicare cover therapy at home?
Medicare covers home health therapy at no cost to you if you are homebound and a provider orders it. Outpatient therapy you travel to is covered under Part B with the usual deductible and coinsurance.
Do I need a referral for Medicare to pay for physical therapy?
You can start with a therapist directly in Indiana, but Medicare pays only when a physician or qualified provider certifies the plan of care, so your therapist sends it for signature after the evaluation.
Keep reading
- Does Medicare limit how many physical therapy visits I get?
- How much does physical therapy cost with insurance?
- Home health physical therapy vs outpatient: which do I need?
- Medicare physical therapy coverage explained
- Medigap and physical therapy
- Balance and fall prevention therapy in Carmel
Sources
This page is general education, not medical advice. A physical therapist can only advise on your situation after an examination.
