About Eugene Thomas Expertise I love to answer questions in Life and Health Insurance, especially those related to Medicare, Medicare Advantage plans, Medicare supplements, and health insurance for individuals and families under age 65.
Experience I am the Principal Agent Manager and Principal Trainer of a force of 300 agents at an insurance call center that does business in 48 states: Bloom Insurance Agency. I am in charge of developing training materials and training schedules, speaking with carrier representatives and carrier trainers, and training in sales.
Education/Credentials I actually have a doctorate in music (vocal performance), but have taught computer programming for business at a top-rated business school in a Big 10 university, not to mention my work as a teacher of insurance.
Question Hello - I have a question about Medicare and Medicare supplement plans. This is for someone who is currently on a group health plan that provides unlimited physical therapy visits. Anyway, he is a recovering quadiplegic (from ocean accident two years ago) and has physical therapy three times a week - and it is necessary for him to have this in order to recover. His Cobra is going to expire soon and he will be then go on Medicare. What is the best Medicare supplemental plan for him to buy given his situation? Also, what are the physical therapy benefits on just the plain wrap Medicare plan? We are in California. Thanks so much!
Answer Janice
Good afternoon!
You will pay for PT through Medicare Part B after COBRA is exhausted, according to the scenario you've presented. Therefore, you will pay 20% of the costs and Medicare will pay 80%, after a $135 deductible, if you don't get a Medicare Supplement. Medicare limits payment of Physical Therapy to $1,840 for PT and Speech Therapy combined, which includes the deductible and billed amounts. Occupational Therapy gets another $1,840. These are yearly limits, and the limits may change from year to year. These are 2009 limits, and apply to outpatient therapy away from the hospital. There are no limits to therapies received in a hospital outpatient PT clinic or for therapy received in an ER. Exceptions for PT to go beyond the limits are available, if your therapist can prove to Medicare that PT is medically necessary beyond those limits.
Document 10988 from medicare.gov explains how Medicare limits and treats therapies.
I would recommend a Medicare supplement Plan F or J. Both of these cover all Part B cost-sharing not covered by Medicare. J is the most comprehensive of all Medicare supplement plans, but an F plan is usually good enough for everyone. Supplement J has an At-Home Recovery Benefit and a Preventive Services benefit that an F plan won't have. Some supplements may be changing next year, according to NAIC, including Plan Js, so F is the safest at this point if you don't need those two benefits. F can also be cheaper.
In California, you have 6 months beginning the month of your Medicare Part B eligibility, even under the age of 65, to buy a Medicare Supplement. Purchase it within 63 of losing COBRA to make sure that no pre-existing conditions will be excluded (which they won't if you get into one in the first 6 months of your eligibility anyway).
