You have that conversation with your doctor, surgeon, neurologist, etc. suggesting that therapy is the solution to allow you resume your prior levels of function and independence for optimal quality of life following some sort of setback. It sounds great, and simple for that matter, right? It is, if you know the extent of what is available to you.

Based on the conversations that I have with patients, family members, and caregivers, it can be really confusing as to how this “simple solution” looks based on the lack of knowledge as to the extent of therapy and support that your insurance coverage provides for. Most individuals elect to obtain traditional Medicare coverage, rather than a Medicare Replacement Plan (that’s a whole different conversation to be had). Because of this, I find it really helpful to understand how our traditional Medicare system works, and actually allows you to maximize your therapy process to get the most treatment and maximal results, so that will be the focus of my message here. First, I like to reinforce to all of our seniors and their families that Medicare benefits are something that you or a spouse have worked for the right to be a part of at age 65. They are earned, and you should use them! So to maximize these benefits that you’ve worked hard for, its important to understand the two primary parts of your Medicare coverage that relate to rehabilitation and therapy treatment: Parts A and B.

For therapy purposes, Medicare part A provides coverage for your inpatient care and treatment. When this is the case, your treatment is covered for an extended period in the inpatient, hospital, and long term care settings. I know, you’re not getting overly excited about being away from home within these settings, and unfortunately we as outpatient providers do not access these Medicare A benefits. But, these settings are often an important step in beginning your road to recovery. Which lends me to

discuss an often overlooked and misunderstood option that is home health care.

As an outpatient therapy provider, we believe that home health is highly beneficial and often essential to allow you to transition back home while still receiving the nursing, physical therapy, occupational therapy, and speech therapy as needed. It is the first step toward regaining your independence, and if you can take advantage of their services while accessing your part A benefits, we suggest this 100% of the time. These professionals are very well trained, and will come to your home, ALF, or independent living setting to provide the care that you need periodically week to week. This is particularly beneficial if you are ready to return home, but still require nursing care. This is care you are eligible for under part A as a Medicare recipient, and we feel that it is very beneficial in order to allow you to transition back home and progress to the point that you can get the maximal benefit from outpatient care.

Outpatient care is where your Medicare part B benefits (or your Medicare replacement plan) come in to play and take over. Receiving physical, occupational, and speech therapy in the outpatient model allows for one on one treatment with your therapist at a frequency that is best suited to your individual needs, ranging from a single visit each week to up to five visits each week if necessary. This freedom to assess each individual based upon specific needs and the flexibility to provide adequate treatment based on those needs, really allows our seniors to maximize their treatment and coverage in order to reach their personal and functional goals for quality of life. Medicare part B will cover 80% of your costs, while the majority of our seniors do have a secondary, or supplemental insurance plan, in place that most often covers the remaining 20% of the costs.

In the outpatient setting, traditionally you come to your therapist(s) and provider to receive treatment within the clinical setting to regain your independence and prior levels of function. We offer that throughout our 5 Atlas and H2 Health clinics in the far western Kentucky area. However, what we find is that travel, arranging transportation, and financial burdens that can be related often limit our seniors from continuing their care when needed, and often desired.

Our Senior Care program at Atlas bridges this gap between your home health care and outpatient care through partnerships with the many strong assisted living facilities (ALF’s) across our area. With our ALF partners, you can take advantage of your part B benefits (or Medicare replacement plan) while having your outpatient physical, occupational, or speech therapist see you in the comfort of the ALF that you call home, just like the home health model provides. This results in reduced burdens from travel,

transportation, and financial aspects while allowing opportunities for more functional treatment activities within the setting that you function within on a daily basis. After all, if it was easy and effortless to get out and about, you probably wouldn’t need skilled therapy treatment, right? I want to stress a point that we see as a priority in our clinics: our line of work is about the patient, not

the paycheck. Our priority is that those that need care get it at a high quality, with the hope that you’ll become a part of our Atlas/H2 family by finishing your journey back to independence in one of our clinics or through our Senior Care program. However, my intention is to help you understand the traditional Medicare benefits as they relate to therapy and rehabilitation, so that you know what is available and can make an informed decisions that best suits your needs, however that may look. As a Medicare recipient, you have the power to get the help that you need to reach you personal goals, and therapy can help!

I hope this helps, as this is a topic of conversation many times throughout my weeks with both patients and families. It can be confusing and somewhat intimidating at times, so feel free to reach out to us for questions and clarification on how to best meet your therapy needs. We are very blessed in the western Kentucky area with excellent professionals and wonderful people that can help meet these needs, and I encourage you to take advantage!

Steffin Beasley, M.S. CCC/SLP

Director of Senior Care

Atlas Physical Therapy