Coverage By Payer

Several sources of payment and coverage exist for occupational therapy practitioners. Medicare is the single largest insurer in the United States and is typically viewed as the “gold standard” for other insurance payment and coverage policies. Also, for the original Medicare plan, the coverage and payment rules are generally consistent across the country.

However, understanding the payer policies for Medicare Advantage (i.e., managed care), Medicaid, workers' compensation, school systems, and private health insurance coverage is also critical to occupational therapy practitioners. These policies vary by and within each company and by the plan selected by an individual contracting entity (e.g., employer, state agency).