Quick answer
Usually, yes. Physical therapy is a rehabilitative service, which is one of the ACA’s essential health benefits, so Marketplace plans cover it when it’s medically necessary, like after surgery, an injury or a stroke. Most plans limit the number of visits per year and charge a copay or coinsurance for each one. Many also require a referral or prior approval.
Key takeaways
- ACA plans and most job-based plans cover medically necessary physical therapy.
- Many plans set a yearly visit limit, so check your plan’s summary of benefits. For chiropractic care, see does insurance cover chiropractors.
- Expect a copay or coinsurance for each visit, and your deductible may apply first.
- Medicare Part B covers medically necessary outpatient PT with no yearly dollar cap; you pay 20% after the deductible.
- PT for general fitness or wellness usually isn’t covered.
On this page
What’s usually covered
| Usually covered | Often not covered |
|---|---|
| PT after surgery, like a knee or hip replacement | Sessions for general fitness or wellness |
| PT after an injury, accident or stroke | Visits beyond your plan’s yearly limit |
| Therapy for conditions like back pain or arthritis | Out-of-network therapists on HMO and EPO plans |
| Therapy that helps kids gain skills they haven’t developed | Care without a treatment plan or progress notes |
PT can help you recover after surgery and sometimes helps you avoid it. For pain, it can reduce how much you rely on prescription drugs.
How to get PT covered
- Check your benefits. Look up your plan’s visit limit, copay and whether you need a referral.
- Get a referral or prescription if your plan requires one. In many states you can see a physical therapist without a referral, but your plan may still want one to pay.
- Use an in-network therapist. See how to find out if a provider is covered.
- Ask about prior approval. Some plans approve a set number of visits at a time and need progress notes for more.
- Appeal if you’re denied. Your therapist can send notes showing you’re improving and still need care.
What you’ll pay
Most plans charge a copay or coinsurance for each visit. If your plan applies the deductible first, you may pay the full negotiated rate until you meet it; see do copays count toward your deductible and what is coinsurance. Since PT often means two or three visits a week for several weeks, per-visit costs add up. HSA and FSA money can pay for it.
Equipment like crutches, braces or a walker usually falls under durable medical equipment, which may have separate rules; see will health insurance pay for wheelchairs.
Medicare
Medicare Part B covers medically necessary outpatient physical therapy. After the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount. There’s no limit on how much Medicare pays for medically necessary outpatient therapy in a year.
Choosing a plan
If you expect to need PT, compare visit limits and per-visit costs, not just premiums. See comparing health insurance plans, types of health insurance coverage and the best health insurance companies.
Job-based plans often have richer therapy benefits, so think it through before you drop your employer’s plan. ACA plans bought through the Marketplace or outside the exchanges include rehabilitative services, while short-term plans may not.
Looking at other hands-on care? See acupuncture and massage.
Compare plans in your area: see quotes by ZIP code.
Frequently asked questions
How many physical therapy visits does insurance cover?
It depends on your plan. Many plans set a yearly limit, which you’ll find in the summary of benefits.
Do I need a referral for physical therapy?
Many states let you see a physical therapist directly, but your plan may still require a referral or prior approval to pay.
Does insurance cover PT if I didn’t have surgery?
Yes, if it’s medically necessary, such as for back pain, an injury or arthritis.
Does Medicare cover physical therapy?
Yes. Part B covers medically necessary outpatient PT; you pay 20% after the deductible.
Sources
This article is general information, not medical advice. Last reviewed September 2026.