Fri, Dec. 06

Letter: Therapy cap takes away your choice


Many folks in and around the Verde Valley may be unaware that a ‘hard cap’ on all Medicare beneficiaries physical therapy care went into place on January 1, 2010. I am referring to the financial limit on the amount of therapy care that Medicare will cover in a calendar year, often referred to as the Medicare “therapy cap.” Currently, there is an $1860 per patient, per year therapy cap for physical therapy and speech therapy COMBINED! In years past, there has been “exceptions” to the therapy cap for patients in dire need of therapy care. The “exceptions” would help with the major conditions such as recovering from a stroke, joint replacement, rotator cuff surgery, or hip and shoulder fractures, which typically take more time to heal or are guided by physician specific protocols.

As of January 1st every beneficiary, regardless of their condition or medical history, is limited to $1860 of physical therapist and speech language pathologist services combined and $1860 for occupational therapist services. Any Medicare patient who is coping with a chronic condition, debilitating illness or significant reconstructive surgery knows that $1860 is hopelessly inadequate to cover the extensive physical therapy those situations require. Any Medicare beneficiary who is worried about having more than one injury or illness that requires therapy care during the year will face having to “ration” his or her limited benefits to avoid having to pay “out of pocket” if they need additional care.

Congress can do something to protect beneficiaries from losing their Medicare coverage. They can pass legislation this year (H.R. 43/S. 46) that repeals this arbitrary, ill-conceived policy once and for all. Congress needs to take action as soon as possible, as some patients are on the verge of meeting their $1,860 cap already. I urge everyone who has a family member on Medicare or who is relying on Medicare coverage themselves to contact our members of Congress immediately and demand that they take action to repeal the Medicare “therapy cap” once and for all.

Tarrin Walz, PT, MS

Northern Arizona Rehabilitation & Fitness


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