The Hidden Gap in Medicare (and How to Stay Ahead of It)
As a physical therapist who’s spent decades working with older adults, I’ve seen firsthand how life-changing the right movement and exercise program can be. But I’ve also seen the frustration that comes with navigating the healthcare system, especially when it comes to what Medicare will and won’t cover. Let’s be honest: it’s confusing, restrictive, and sometimes feels like it works against the very idea of staying healthy and independent.
Medicare is designed to cover medical necessity—meaning services that help you recover from an illness, injury, or decline in your ability to perform basic daily tasks such as bathing, dressing, walking, or getting in and out of a chair. In Medicare’s own language, physical therapy is covered when it helps you regain the ability to perform activities of daily living (ADLs), not for improving your strength or balance so you can comfortably play pickleball, garden, travel, or keep up with your grandkids. Those activities, while vital to quality of life, are considered extracurricular, and therefore not “medically necessary.”
Medicare Myth vs. Fact
Myth: “Medicare will cover physical therapy if I just want to get stronger or prevent a fall.”
Fact: Medicare only covers therapy that is considered medically necessary, meaning you’ve experienced a loss of function or are at risk of losing the ability to perform daily living tasks like dressing, bathing, or walking safely and independently. Wellness-based or preventive programs, even when supervised by a licensed physical therapist, are not covered under traditional Medicare.
This is one of the most misunderstood parts of the system. People often come to me while they’re still doing well. They’re independent with mobility and self-care, and that’s fantastic. They tell me they just want to be stronger, steadier, or more confident on their feet. I love that proactive mindset; it’s exactly what we want! But the catch is that Medicare doesn’t recognize “getting stronger” as a covered goal unless it directly relates to basic daily living skills.
It’s a frustrating paradox: Medicare will pay for therapy after you’ve fallen or lost function, but not for the support that could help you avoid those setbacks altogether. Yet prevention is exactly where the biggest gains are made. According to the CDC, one in four adults over 65 experiences a fall each year, and those falls are a leading cause of injury-related hospitalizations. But most falls are preventable through targeted exercise, balance training, and education—exactly the kind of work we do every day in the studio.
That’s why I’ve built my programs to fill the gap between medical care and wellness. At my studio, we focus on movement as medicine—improving balance, flexibility, posture, and strength in ways that support independence and confidence. From “Tai Chi for Arthritis & Fall Prevention” to “Yoga for Functional Strength,” to our Silver Sneakers and private wellness sessions, every class or session is designed to help you move better and feel better.
And here’s an important truth: investing in your health now is far less expensive than paying for care later. A few months of consistent exercise and education can save you from thousands of dollars in hospital bills, long-term care costs, or the loss of independence that so often follows preventable injuries.
So while Medicare may draw a hard line on what’s “medically necessary,” you don’t have to wait for permission to take control of your health. Staying proactive gives you power—the power to move with confidence, maintain your independence, and keep doing the things you love.
Take the Next Step Toward Lifelong Strength and Stability
If you’re ready to be proactive about your health, we have programs designed specifically for you. Explore our upcoming classes and treatment options for adults 50+, including tai chi, yoga, balance training, and personalized wellness sessions. Let’s keep you strong, stable, and independent, one step at a time.