How Plan N works with Medicare - Physical Therapy

Plan N acts as secondary insurance to Original Medicare (Part A and Part B). It only pays if Medicare covers the service first:

100% Coinsurance Coverage: After you meet your annual Part B deductible, Plan N pays the full 20% coinsurance for medically necessary physical therapy.
No $20 Copay: While Plan N often requires a copay of up to $20 for office visits, this typically does not apply to physical therapy sessions.
Settings: Coverage applies to therapy in outpatient clinics, doctor's offices, skilled nursing facilities, or even at home.

Out-of-Pocket Costs with Plan N
While Plan N is comprehensive, you are still responsible for certain costs:

Part B Deductible: You must pay the annual Medicare Part B deductible ($257 in 2025; $283 in 2026) before Plan N starts covering the 20% coinsurance.
Part B Excess Charges: Plan N does not cover "excess charges." These occur if a provider does not accept "Medicare assignment" and charges up to 15% more than the Medicare-approved amount. You must pay this 15% yourself unless you live in a state that prohibits excess charges.

Core Medicare Requirements for Coverage

For Plan N to trigger coverage, the therapy must meet Medicare's standard rules:

Medical Necessity: Your doctor or healthcare provider must certify that the therapy is medically necessary to treat or manage your condition.
Referral: Most providers require a referral or a written care plan to prove medical necessity.
Therapy Thresholds: There is no limit on the number of sessions, but once your total therapy costs reach a certain threshold ($2,480 in 2026), your therapist must provide additional documentation to justify continued care.

Do you need help determining if your specific state prohibits the Part B excess charges that Plan N doesn't cover?