Will My Medicare Coverage Be Denied for Skilled Therapy if My Condition Does Not Improve?

Medicare covers SNF, home health, and outpatient therapy care regardless of whether your condition is temporary or chronic, or whether your condition is improving or not, as long as the care is medically necessary for another reason. This was clarified in the settlement of a class-action lawsuit, Jimmo v. Sebelius. The settlement agreement explained that an improvement standard cannot be the only test applied when Medicare is determining coverage of claims that require skilled care, such as skilled therapy. Medicare covers services that are needed to:

  • Help maintain the ability to function
  • Help regain or improve your function
  • Prevent or slow the worsening of your condition

Read More: Which Skilled Therapy Are Covered Under Medicare?
Learn About: Am I Eligible for Medicare Coverage for Outpatient Therapy Services?
Return to: Medicare In-Depth

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