ATF · FOR PATIENTS, CLIENTS AND FAMILIES
Does Medicare cover aquatic therapy?
Often, yes. Here is what helps therapy in a pool get covered, what to ask your clinic, and what to do if Medicare says no.
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. See competing-interest statement.
Last reviewed: October 23, 2026
How to cite this page
How to cite
Salzman, A. (Ed.). (2026). Does Medicare cover aquatic therapy? ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-participants/does-medicare-cover-aquatic-therapy/
Click the citation (or press and hold on a phone) to select it, then copy. Add the date you read the page. Permissions and the full citation are in How to cite this page near the bottom.
Can Medicare help pay for therapy in a pool?
Yes, it can. Aquatic therapy is physical or occupational therapy done in a pool. Medicare Part B helps pay for outpatient therapy that is medically necessary, and therapy in water follows the same rules as therapy on land.1,2
- After you meet the yearly Part B deductible, you usually pay 20% of the Medicare-approved amount.1
- There is no yearly dollar limit on medically necessary outpatient therapy.1
- Therapy can be covered to help you improve, to keep the abilities you have, or to slow a decline.1,2
Water exercise classes for general fitness are different. Medicare does not count general exercise to stay fit as therapy, even when it is in a pool.2
What helps your therapy get covered
Two things matter most. Your clinic handles the paperwork, but it helps to know what they are.
A plan of care
Your therapist writes a plan for your care: your goals, what you will work on and for how long. Your doctor or another approved health care provider, such as a nurse practitioner or physician assistant, signs it to confirm that you need therapy.1,2
A real need for skilled therapy
The care must need the skills of a therapist, not just a place to exercise. You do not have to be getting better to qualify. What counts is that you need a therapist’s skilled care.2
Your therapist should explain why the pool helps you, for example if pain, weakness or balance make exercise on land hard right now. As you get stronger, the plan may move some or all of your exercise to land or to a program you can do on your own.
Questions to ask the clinic
Before your first pool visit, ask the clinic’s front desk or billing office:
- Is it covered? Will Medicare, or my Medicare Advantage plan, likely cover my therapy in the pool?
- What will I pay? What will my share be for each visit, and does it change after I meet my deductible?
- Do I need prior approval? If I have a Medicare Advantage plan, does my plan need to approve this therapy before I start? Medicare Advantage plans often need approval first for certain services.3
- Is the clinic in my plan’s network? This matters most with Medicare Advantage.
- Will you tell me before I get care Medicare may not pay for?
Tip: Write down the date, the name of the person you spoke with and what they said.
If the clinic gives you an Advance Beneficiary Notice
With Original Medicare, a clinic may give you a form called an Advance Beneficiary Notice (ABN) if it thinks Medicare may not pay for a service. It lists the service, the estimated cost and the reason.4
An ABN is not a denial from Medicare.4 It is the clinic warning you ahead of time. You choose one of three options and sign:
Option 1
Get the care and ask the clinic to send a claim to Medicare. You may need to pay now. If Medicare says no, you can appeal. If Medicare pays, the clinic gives you back what you paid, other than your usual copay or deductible.4
Option 2
Get the care but ask the clinic not to send a claim. You pay, and you cannot appeal.4
Option 3
Do not get the care. You do not pay, and no claim is sent.4
Not sure which to choose? Ask the clinic why they think Medicare may not pay, and ask for a copy of the signed form.
If Medicare says no: how to appeal
You have the right to appeal. Appeals have five levels, and you start at the first one.5
With Original Medicare
- Look at your Medicare Summary Notice, the statement Medicare mails you. It shows what was denied and the date your appeal is due.6
- Fill out the Redetermination Request Form, or write a letter. Circle the denied items on a copy of the notice, say why you think they should be covered, and add a note from your doctor or therapist if you can.6
- Send it to the address on the notice. You will usually get a decision within 60 days.6
With a Medicare Advantage plan
- Follow the steps in your plan’s denial letter. You, someone you choose or your doctor must appeal within 65 days of the date on that letter.7
- If the therapy has not happened yet, your doctor can ask for the review for you.7
- If waiting could seriously harm your health, ask for a fast appeal. The plan must decide within 72 hours. A standard appeal for care you have not had yet takes up to 30 days.7
You do not have to do this alone
Your State Health Insurance Assistance Program gives free, one-on-one Medicare help, including with appeals. Find yours at shiphelp.org.8,5
You can also call 1-800-MEDICARE, which is 1-800-633-4227. TTY users can call 1-877-486-2048.6
You can name a family member, friend or other person to act for you in an appeal.5
Questions people ask
Does Medicare limit how many pool visits I can have?
There is no yearly dollar limit on medically necessary outpatient therapy.1 Your visits depend on your plan of care and your need for skilled therapy. Medicare Advantage plans may have their own approval rules, so ask your plan.3
Will Medicare pay for a pool membership or water exercise class?
Usually not. Medicare does not count general exercise for fitness as therapy.2 If you have a Medicare Advantage plan, ask whether it offers any fitness benefits.
I have Medicare Advantage. Is it different?
It can be. Your plan may need to approve therapy before you start, and it may want you to use clinics in its network.3 Call the member number on your plan card.
My therapy is to keep me from getting worse. Can that be covered?
Yes, it can. Medicare can cover therapy to keep your current abilities or slow a decline, as long as you need a therapist’s skilled care.1,2
Who can help me understand a bill or a denial?
Your clinic’s billing office is a good first call. For free, independent help, contact your State Health Insurance Assistance Program at shiphelp.org, or call 1-800-MEDICARE.8,6
How to cite this page
Last reviewed October 23, 2026 · Permanent URL: https://aquatictherapyfoundation.org/for-participants/does-medicare-cover-aquatic-therapy/
Salzman, A. (Ed.). (2026). Does Medicare cover aquatic therapy? ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-participants/does-medicare-cover-aquatic-therapy/
Permissions: This page is free to read, share by link, quote and cite with attribution. Copying, republishing, adapting or selling the page or any substantial part of it requires written permission from ATU Educational Services, LLC.
Cite the date you accessed this page, because content may change.
References
Every source cited on this page, in American Medical Association style. All come from official Medicare sources or the national Medicare help program. Checked on October 23, 2026.
- Centers for Medicare & Medicaid Services. Physical therapy services. Medicare.gov. Accessed October 23, 2026. medicare.gov
- Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15: Covered Medical and Other Health Services, section 220 (Revision 13889, issued July 30, 2026). Accessed October 23, 2026. cms.gov (PDF)
- Centers for Medicare & Medicaid Services. Compare Original Medicare and Medicare Advantage. Medicare.gov. Accessed October 23, 2026. medicare.gov
- Centers for Medicare & Medicaid Services. Your protections: Advance Beneficiary Notice of Non-coverage. Medicare.gov. Accessed October 23, 2026. medicare.gov
- Centers for Medicare & Medicaid Services. Appeals. Medicare.gov. Accessed October 23, 2026. medicare.gov
- Centers for Medicare & Medicaid Services. Appeals in Original Medicare. Medicare.gov. Accessed October 23, 2026. medicare.gov
- Centers for Medicare & Medicaid Services. Appeals in Medicare health plans. Medicare.gov. Accessed October 23, 2026. medicare.gov
- State Health Insurance Assistance Program National Technical Assistance Center. Find your local Medicare help. SHIPhelp.org. Accessed October 23, 2026. shiphelp.org
About this page
Competing interests
This page was prepared under the direction of Aquatic Therapy Foundation leadership. The copyright holder, ATU Educational Services, LLC, sells continuing education for clinicians. This page does not sell, rank or recommend any course, clinic, plan or product, and the Aquatic Therapy Foundation does not endorse any provider.
Copyright
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. Free to read and cite; not to be copied or sold. Medicare.gov and other cited works keep their own terms.
Corrections and questions
Spot an error or an out-of-date link? Contact us at info@aquatictherapyfoundation.org. We cannot answer questions about your own bill or coverage. For that, call your plan or 1-800-MEDICARE.
How this page was made: This page was drafted with AI assistance under the editorial direction of ATU Educational Services, LLC, checked against the official Medicare sources listed above, and corrected when errors are reported. Report errors to info@aquatictherapyfoundation.org.
Disclaimer: This page is general information only, not legal, medical or billing advice, and it cannot promise that Medicare will pay. Rules change; check with your therapist and with Medicare at 1-800-MEDICARE (1-800-633-4227) or Medicare.gov. Last reviewed October 23, 2026. Full notice
Editor: Andrea Salzman, MS, PT · ORCID: https://orcid.org/0009-0009-5255-7074
Copyright: © 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education.