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Therapy “Plateau” No Longer Stops Medicare Coverage

A class-action lawsuit last month has prohibited Medicare from denying patients coverage for reaching a “plateau,” meaning their conditions are not improving.

Medicare patients with chronic health problems or disabilities that require nursing care, home health services or outpatient therapy will be able to continue to receive the skilled care they need for as long as they need it, as long as they meet other coverage criteria.

The settlement is expected to affect thousands, and possibly millions, of Medicare beneficiaries with chronic health problems like Parkinson’s or Alzheimer’s disease, stroke, multiple sclerosis and spinal cord injuries. Coverage will continue as long as it is considered medically necessary by the patient’s physician.

Congress also continued for another year a little-known process that allows exceptions to what Medicare pays for physical, occupational and speech therapy. The Medicare limits before the exceptions are $1,900 for physical and speech therapy this year, and $1,900 for occupational therapy. Read the full details here:

Therapy Plateau No Longer Ends Coverage

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