Medicare has annual caps for therapy sessions; Covering; The Bases

I have always been an avid surfer and at age 67 still ride the waves. On a recent visit to Southern California I had a wipeout and took a surfboard to the face. I broke my jaw and strained my neck. I had jaw surgery and started speech therapy. I also started physical therapy for my neck.

I am on the mend but not quite back to normal. I was told that there is a cap on the number of therapy sessions that Medicare will cover. What if I reach the cap and still am in need of therapy? FYI, I have Original Medicare and a Medigap plan.

I am sorry to hear about your mishap but pleased you are recovering.

Your doctor has ordered therapy to aid in your recovery. You are correct, Medicare has set annual "therapy caps" for physical therapy, speech therapy and occupational therapy. For 2017, Medicare covers a total of $1,980 worth of physical therapy and speech therapy, combined. Medicare covers an additional $1,980 of occupational therapy.

Since your doctor has ordered both physical therapy and speech therapy, you are subject to the $1,980 annual therapy cap for these therapies. It is possible that you will achieve your therapy goals prior to the $1,980 limit. However, if you reach your annual therapy limit and your doctor believes it is medically necessary for you to continue therapy, your doctor may request that further therapy be covered. Medicare will likely grant an exception and continue to cover the medically necessary therapy sessions.

I am turning 65 in April. I see so much on TV about Medicare's annual enrollment period. From what I can tell, I have to make my decisions by Dec. 7. This seems premature for me to make any Medicare selections.

Since you are not yet 65 and will turn 65 in April, you have a different timeframe to make your Medicare decisions. As a general rule, you have the three months prior to your birth month (January, February and March); the month you turn 65 (April); and up to three months after your birth month (May, June and July) to make your Medicare decisions. (Please note, if you were born on the first of the month, these timeframes will begin a month earlier.)

You may begin to learn about your Medicare options by visiting www.medicare.gov. You may also review the booklet "Medicare and You" that is available online or by calling 1-800-MEDICARE. You may also contact your local Department of Aging and Disabilities' State Health Insurance Assistance Program to review your options.

Please note, not everyone needs to enroll into Medicare at age 65. Many people are currently working (or their spouses are currently working) and are covered under employer health plans based on active employment. These situations allow for a special enrollment period after age 65. If this is your situation, please pay special attention to the information on special enrollment periods when reviewing the "Medicare and You" booklet.

Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging

and Disabilities. You may contact either program at 410-222-4257 or ship_program@aacounty.org.

Credit: Amy Rubino - Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging ;and Disabilities. You may contact either program at 410-222-4257 or ship_program@aacounty.org.