Does Health Insurance Cover Physical Therapy?

Picture this: You wake up with a sharp ache in your lower back. You try to stretch, but the pain only gets worse. Your doctor says you need physical therapy. The first question that pops into your head—does health insurance cover physical therapy? If you’ve ever found yourself wincing at a medical bill, you know why this matters. The answer isn’t as simple as yes or no, but I’ll walk you through what you need to know, what to watch out for, and how to avoid surprises.

Why Physical Therapy Matters

Physical therapy isn’t just for athletes or people recovering from surgery. It helps with everything from chronic pain to mobility issues after an accident. Maybe you slipped on ice, or maybe your desk job has left your shoulders in knots. Physical therapy can help you move better, hurt less, and get back to your life. But it can also get expensive—fast. That’s where health insurance comes in.

Does Health Insurance Cover Physical Therapy?

Here’s the part nobody tells you: most health insurance plans do cover physical therapy, but the details can get tricky. The answer to “does health insurance cover physical therapy” depends on your specific plan, your diagnosis, and even your therapist’s credentials. Let’s break it down.

What Most Plans Cover

Most employer-sponsored and individual health insurance plans include physical therapy as a covered benefit. The Affordable Care Act (ACA) even lists it as an “essential health benefit.” That means if you have an ACA-compliant plan, you’re likely covered. But—there’s always a but—coverage comes with conditions.

• Medical necessity: Your doctor usually needs to say physical therapy is medically necessary. That means you can’t just book a session because you want a better golf swing.
• Referral or pre-authorization: Many plans require a referral from your primary care doctor or pre-authorization from the insurance company before you start therapy.
• In-network providers: You’ll pay less if you see a therapist in your insurance network. Out-of-network visits can cost a lot more—or may not be covered at all.
• Session limits: Some plans cap the number of sessions per year. For example, you might get 20 visits covered, and then you’re on your own.
• Copays and coinsurance: Even with coverage, you’ll probably pay a copay (like $20 per visit) or coinsurance (a percentage of the cost).

If you’re thinking, “Wait, so does health insurance cover physical therapy for my specific situation?”—keep reading. The devil’s in the details.

What Insurance Companies Don’t Always Tell You

Here’s a story: My friend Sarah hurt her knee running. Her doctor sent her to physical therapy. She assumed her insurance would cover it. After a few weeks, she got a bill for $600. Turns out, her plan only covered 10 sessions, and she’d gone to 15. Ouch.

If you’ve ever been blindsided by a bill, you know how frustrating this feels. Insurance companies don’t always make it easy to understand what’s covered. Sometimes, the language in your policy is confusing on purpose. Here’s what you need to watch for:

• Session limits: Check your plan for annual or lifetime limits on physical therapy visits.
• Diagnosis codes: Some plans only cover therapy for certain diagnoses. If your doctor uses the “wrong” code, your claim could get denied.
• Out-of-pocket maximums: Once you hit this number, your insurance pays 100%—but until then, you’re responsible for copays and coinsurance.
• Deductibles: If you haven’t met your deductible, you’ll pay the full cost of therapy until you do.

Here’s why this matters: If you don’t know your plan’s rules, you could end up paying way more than you expect. Always call your insurance company before you start therapy. Ask them, “Does health insurance cover physical therapy for my diagnosis? How many sessions? What will I pay per visit?” Write down the answers. Get names and reference numbers. It’s not fun, but it can save you hundreds—or thousands—of dollars.

Medicare, Medicaid, and Physical Therapy

If you’re on Medicare, the rules are a little different. Medicare Part B covers physical therapy if it’s medically necessary and provided by a qualified therapist. There’s no longer a hard cap on how much Medicare will pay, but if your therapy costs more than a certain amount (about $2,230 in 2024), your provider has to confirm that it’s still medically necessary.

Medicaid coverage varies by state. Some states cover unlimited therapy; others have strict limits. If you have Medicaid, check your state’s rules or call your caseworker.

What About High-Deductible Plans?

High-deductible health plans (HDHPs) are common now. If you have one, you’ll pay the full cost of physical therapy until you meet your deductible. After that, your insurance kicks in. This can mean paying $100 or more per session out of pocket at first. If you have a Health Savings Account (HSA), you can use those funds to pay for therapy.

Tips to Get the Most from Your Coverage

1. Get a referral: Even if your plan doesn’t require it, a referral from your doctor can help with insurance approval.
2. Choose in-network therapists: Always check if your therapist is in-network. Out-of-network costs can be double—or more.
3. Ask about session limits: Don’t assume you have unlimited visits. Ask your insurer for the exact number.
4. Track your visits: Keep a record of each session. Don’t rely on your provider or insurer to do this for you.
5. Appeal denied claims: If your claim gets denied, don’t give up. You can appeal. Sometimes, a simple phone call or letter from your doctor can turn things around.

Who Should (and Shouldn’t) Rely on Insurance for Physical Therapy?

If you have a chronic condition, recent injury, or post-surgery pain, insurance can make physical therapy affordable. But if you want therapy for general wellness, athletic performance, or “tune-ups,” your plan probably won’t pay. In those cases, you’ll pay out of pocket. Some clinics offer cash discounts or package deals—ask about these if you’re paying yourself.

What to Do Next

If you’re still wondering, “Does health insurance cover physical therapy for me?”—grab your insurance card and call the number on the back. Ask about your benefits, session limits, and costs. If you’re already in therapy, talk to your provider’s billing office. They deal with insurance every day and can help you avoid surprises.

Here’s the truth: Health insurance usually covers physical therapy, but only if you play by the rules. The more you know, the less you’ll pay—and the faster you’ll get back to feeling like yourself. If you’ve ever felt lost in the maze of insurance, you’re not alone. But now, you’ve got a map.