Despite the benefits of early, targeted exercise, insurance coverage lags behind the evidence
Fact checked by Jim Lacy
Three mornings a week, Lakeview resident Bob Stevenson (not his real name) joins a Parkinson’s-specific group exercise class at Shirley Ryan AbilityLab’s Adaptive Sports and Fitness Center.
He was diagnosed with Parkinson’s disease in 2010. He remained active for years through Parkinson’s-specific exercise programs not covered by traditional insurance. Only recently, nearly 15 years later, did he begin formal physical therapy, along with occupational and speech therapy.
“They’re helpful,” Stevenson says of the exercise programs he has relied on over the years. “But you pay for them yourself.”
His experience is not unusual. It reflects a broader disconnect in Parkinson’s care. Research increasingly supports early, targeted exercise to preserve mobility and function. Yet many programs designed to deliver consistent, Parkinson’s-specific movement support fall into a gray zone between therapy and wellness.
When care looks like exercise
Physical therapists commonly bill for therapeutic exercise. The problem is that routine exercise classes aren’t considered skilled or therapeutic, so insurance doesn’t cover them. “Once an individual can independently complete an exercise routine on their own or in a community class, it typically no longer qualifies for insurance coverage,” says Miriam Rafferty, DPT, PhD, a physical therapist and Parkinson’s researcher at Shirley Ryan AbilityLab.
Medicare reimburses time-limited physical, occupational, and speech therapy for documented, skilled need, Rafferty says. However, it does not reimburse ongoing, structured exercise, even when it is Parkinson’s-specific.
“People often don’t feel ‘bad enough’ yet to qualify for therapy. But that’s exactly when intervention could have the biggest impact.”
“Exercise is beneficial at almost any stage,” Rafferty says. “But timing matters. When people start earlier, before they have lost function, they are more likely to maintain mobility longer.”
What benefits someone in the earliest stages of Parkinson’s looks very different from what they may need a decade later.
“For people with very mild Parkinson’s, we’re talking about high-intensity treadmill training, progressive strength training, and education about what to do and how often,” Rafferty says. “That’s different from later-stage therapy, when the focus may be compensating for loss.”
Early, coordinated care
At Shirley Ryan AbilityLab, that understanding has translated into a comprehensive Parkinson’s Disease and Movement Disorders program that blends clinical care, research, fitness services, and patient education.
The hospital offers interdisciplinary Parkinson’s screening visits with physical therapists, occupational therapists, and speech-language pathologists. Physicians can bill for those encounters. Therapists generally cannot bill for brief screening assessments conducted during the visit.
“So the organization makes a decision: We absorb the cost because we believe early, coordinated care matters,” Rafferty says, calling it a deliberate business choice that many health systems cannot afford.
While interdisciplinary Parkinson’s clinics exist nationwide, she says, they often serve small patient populations and rely on institutional or philanthropic support. Group-based, multidisciplinary programs offered early in the disease are even rarer.
“Parkinson’s is not high blood pressure,” Rafferty says. “It’s a smaller population, which makes it harder to justify specialized clinics without research or philanthropic backing.”
The space insurance leaves behind
At the Madison Meadow Athletic Center in suburban Lombard, a nonprofit program called m.o.v.e. helps fill that gap.
The clinician-designed program brings together physical therapy, occupational therapy, speech therapy, and social work in Parkinson’s-specific group sessions for people diagnosed within the past 10 years. Classes run twice a week for 90 minutes, and caregivers are encouraged to attend. Education and health literacy are woven into each session.
“Ongoing, interdisciplinary, group-based care does not fit cleanly into current reimbursement models,” says Nicole Bettin, DPT, an assistant professor of physical therapy and director of clinical education at North Central College. She is also m.o.v.e.’s principal researcher. “We designed this as a research-supported, community-based model while we collect the data.”
Participants attend at no cost while researchers track mobility, cognition, fine motor skills, and longer-term exercise habits.
“We’re not replacing therapy,” Bettin says. “We’re filling the space before people ever get there, or between therapy cycles, when movement still matters but there’s no obvious place for it in the system.”
That timing is intentional. “People often don’t feel ‘bad enough’ yet to qualify for therapy,” says Erica Fenton, the program’s founder and executive director. “But that’s exactly when intervention could have the biggest impact.”
The program also incorporates social work and caregiver education, features that remain rare in exercise-based Parkinson’s programs.
“Caregivers are often trying to figure everything out on their own,” Fenton says. “If we can support them early, we’re supporting the patient long term.”
As policymakers debate how to better align coverage with prevention and functional preservation, programs like m.o.v.e. offer a glimpse of what Parkinson’s care could look like if reimbursement caught up with evidence.
M.o.v.e.’s next research cohort is scheduled to begin in June 2026. Learn more at movefound.org.
