Original Medicare vs. Medicare Advantage for Physical Therapy
Choosing between Original Medicare and Medicare Advantage affects which physical therapists you can see, how much you pay, and whether you need approvals before care. No Limit Physical Therapy accepts Original Medicare Part B and private pay. This guide explains the key differences for physical therapy so you can make an informed choice.
Request an AppointmentSide-by-Side Comparison
| Original Medicare | Medicare Advantage (Part C) | |
|---|---|---|
| Who runs it | The federal government | Private insurance companies approved by Medicare |
| Choice of providers | Any provider in the U.S. that accepts Medicare | Usually limited to the plan’s network |
| Referrals and prior authorization | Physical therapy does not require insurer prior authorization | Plans may require referrals or prior authorization for therapy |
| Cost sharing for PT | 20% coinsurance after the Part B deductible | Plan-specific copays or coinsurance |
| Out-of-pocket maximum | None, unless you add a Medigap plan | Annual out-of-pocket limit set by the plan |
| Extra benefits | Can add Medigap and a separate Part D drug plan | Often bundles drug coverage and extras like dental or vision |
| Accepted at No Limit Physical Therapy? | Yes, Part B | No; private pay is available |
How Original Medicare Covers Physical Therapy
With Original Medicare, Part B covers medically necessary outpatient physical therapy from any provider that accepts Medicare, including in-home outpatient therapy. You pay 20% of the approved amount after the yearly deductible, and a supplemental Medigap plan can help cover that share. Your physician certifies your plan of care, and there is no hard yearly cap on medically necessary therapy. Learn more on our Medicare physical therapy page.
How Medicare Advantage Covers Physical Therapy
Medicare Advantage plans must cover everything Original Medicare covers, but each plan sets its own network, copays, and approval rules. Many plans require you to use in-network therapists, and some require referrals or prior authorization for physical therapy or limit visits before reauthorization. In exchange, plans have an annual out-of-pocket maximum and often include extra benefits.
What This Means for In-Home Physical Therapy
If you have Original Medicare Part B, you can use your benefits for in-home outpatient therapy with No Limit Physical Therapy anywhere in our San Diego service area. If you have Medicare Advantage, check your plan’s network for therapy coverage, or work with us through private pay physical therapy with upfront pricing.
Choosing a Plan
The right choice depends on your health needs, budget, preferred providers, and travel. You can generally change Medicare coverage during the annual Open Enrollment Period each fall. For personalized plan guidance, California residents can contact HICAP, the state’s free Medicare counseling program, or visit Medicare.gov. Whatever you choose, our team is happy to explain how your coverage applies to fall prevention, post-surgical rehabilitation, and in-home therapy for seniors. Also see home health vs. outpatient in-home PT.
Original Medicare vs. Medicare Advantage FAQs
Does No Limit Physical Therapy accept Medicare Advantage?
No. We accept Original Medicare Part B and private pay only.
Does Original Medicare cover in-home physical therapy?
Yes. Part B covers medically necessary outpatient physical therapy, including outpatient therapy provided in your home.
Do Medicare Advantage plans cover physical therapy?
Yes, but coverage depends on the plan’s network, copays, and authorization rules.
Is there a visit limit with Original Medicare?
There is no hard yearly cap on medically necessary therapy. Above an annual threshold, your therapist documents medical necessity.
Can I see you if I have Medicare Advantage?
Yes, on a private pay basis with clear, upfront pricing.
When can I switch from Medicare Advantage to Original Medicare?
Changes are generally made during the annual Open Enrollment Period each fall, and there is also a Medicare Advantage Open Enrollment Period early in the year. Contact Medicare or HICAP for guidance.
Does Medigap work with Medicare Advantage?
No. Medigap plans work only with Original Medicare.
Use Your Original Medicare Benefits at Home
Have Original Medicare Part B? Call (858) 769-6069 or request an appointment online to schedule in-home physical therapy with No Limit Physical Therapy.