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noah

medicare coverage

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I just went on medicare 6/1 and have some questions. I have been going to a pt to help with m y balance.   I had been going twice   per week, but after Jan when my copay went up to 50 per visit I have

been going once per week. She thinks I was doing better twice per week but it got go expensive.   So I found out today that medicare will only pay for 44 visits per year. Thats not enough. I am not sure if my secondary will pay or not  Has anyone run into this problem. 

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Hi, noah. I have Medicare and a supplement and both have paid for PT. Was it someone from Medicare that told you about the 44 visit limit or was it the staff at the clinic? It is my understanding that the number of visits is based on the PT's initial evaluation and on your progress. I suggest checking directly with Medicare. If the PT clinic is private, that limit may apply. For clinics affiliated with a medical center, you can have more visits.

Dianne      

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The business person @ the office told me. I checked the medicare web site and it only pays for 2010 for pt per year which is about 44 visits 

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A call to Medicare could give you more information specific to PD.  A few years ago, a national PD advocacy group successfully lobbied to have PT continue for PWP even if they weren't making progress, but were maintaining a certain level of function. The 44 visit limit may be for each separate problem. If you reach the maximum early in the year for balance then broke your hip in September, they couldn't deny PT for the new condition. 
I sure hope that talking to a live person at Medicare gives you better answers than you've gotten so far. 

Dianne    

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Noah, 

Did you sign-up for a Medicare supplement and, if so,  is it a Medicare Advantage Plan or a Medigap Plan?  These plans often pickup the expenses that Medicare doesn't cover.  You have six months from the date of your Medicare eligibility to sign-up for a Medigap Plan without going through medical underwriting (very important for people who have PD).  The Advantage Plans are very different and in my opinion more costly in the long run for people with a medical condition that requires frequent and long term care.

Good luck!

Gardener

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Check all the details in the supplement plans. Many follow Medicare rules and may be subject to that dollar limit. The rules supposedly changed last year or so about those limits but check very-very carefully. In our community, $2,010 would not begin to cover 44 visits.

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