Medicare’s Alternative Therapy Cap

Medicare’s Alternative Therapy Cap

Alternative therapy may have a bad reputation, but it’s essential to remember that not all treatments work. Whether it’s acupuncture, laser cap or something else entirely, the best way to determine if this type of therapy will benefit you is by consulting your doctor first.

Some health plans cover alternative therapies if there is scientific proof they are beneficial. Check your plan website to see if you can search for a list of therapists in the network. If you don’t have access to the internet, call your insurer and request a list by phone or mail.

In 2011, Medicare implemented annual therapy spending caps that limit the total amount of outpatient therapy a beneficiary can receive. If their therapy expenditures exceed these limits, they must submit additional documentation and undergo review. Unfortunately, beneficiaries may find it challenging to access affordable therapy services. This article analyzes the consequences of changing congressionally-established caps to equal caps by therapy discipline (physical therapy, occupational therapy and speech-language pathology) or a single combined cap and estimates risk adjustments for beneficiaries with high spending. Furthermore, it evaluates the distributional impacts of a single cap on all outpatient therapy users.

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