Does Medicare Cover Speech Therapy
This article was updated on: 09/12/2018
Speech therapy involves a wider scope of treatment than you might think – it can help with social communication skills, thinking and understanding, and even swallowing. If you have a stroke, your doctor might prescribe speech therapy.
Speech therapy: when would you need it?
If you’re a stroke survivor or the caregiver of a stroke survivor, you are not alone. Every year, more than 795,000 people in the United States have strokes, according to the Centers for Disease Control. Some stroke survivors have trouble speaking. You might be diagnosed with aphasia if the stroke damages certain language-related parts of the brain, reports the National Institutes of Health.
Your doctor might order speech therapy to treat your aphasia. There can be other causes of aphasia besides stroke (such as a brain tumor or a head injury), according to the NIH, and other conditions that might be treated with speech therapy. For example, doctors may recommend speech therapy for people who have trouble swallowing.
Speech therapy, also called speech language pathology, may help you regain your language skills. Medicare Part B may help pay some of the costs of speech and language therapy. If you get your Medicare Part A and Part B benefits through a Medicare Advantage plan, the plan will similarly help cover Medicare-approved speech therapy.
Medicare Part A and/or Part B may cover speech therapy if your doctor or other health-care certifies that the care is necessary. If you’re scheduled for speech therapy as part of home health care, there may be more requirements for Medicare to cover these services. For example, you must be getting your care through a Medicare-certified home health agency, and your doctor must create a care plan specifically for you, that includes speech therapy. More details later in this article.
What is speech therapy?
Speech therapy is designed to improve the ability to communicate, according to the National Institutes of Health. Speech therapy might help restore language skills, teach how to compensate for lost language skills, and, if needed, find other ways to communicate. Speech therapy may start with a visit with a speech pathologist and a treatment plan. Often speech therapy involves oral and written language exercises designed around the person’s needs. Other way that speech therapy may help patients include:
- “Re-learning” communication skills
- Practicing conversational speech and how to use cues to help remember words
- Helping with difficulty swallowing – figuring out what’s wrong and working with you to improve your ability to eat and swallow correctly and comfortably.
Does Medicare cover speech therapy?
Medicare Part B (medical insurance) may cover speech therapy, including cognitive (thinking and understanding) and swallowing skills. A doctor or other health-care provider must certify that you need speech therapy. Outpatient speech therapy includes therapy delivered at a hospital outpatient center, rehabilitation facility, doctor’s or therapist’s office, or at home from a Medicare-approved home health-care agency. A plan of treatment must be established and regularly reviewed by a doctor.
Medicare Part A or Part B may also cover speech therapy as part of in-home care provided by a Medicare-approved home health-care agency or provided in a skilled nursing facility.
If you are enrolled in a Medicare Advantage plan, the plan must provide at least the same level of coverage as Medicare Part A and Part B. Hospice care is the exception; Part A covers it. Many Medicare Advantage plans offer additional coverage. Contact your plan directly to find out how much your Medicare Advantage plan will cover for speech therapy and what your cost-share amount (copayment or coinsurance) is.
Does Medicare coverage of speech therapy have a limit or cap?
There may be a limit (called a “cap”) on the amount Medicare Part B will pay for speech therapy services in a single year. After you’ve paid the annual Medicare Part B deductible, Medicare will generally pay up to 80% of the Medicare-approved amount for each service and you will be responsible for the remainder. After the limit (cap) has been reached, you may have to pay the full cost of the services.
If you are approaching the limit and need more speech therapy, your doctor may be able to notify Medicare that it’s medically necessary for you to continue. If you need a lot of care after you have reached the speech therapy cap, your provider may need to get pre-approval from Medicare for your continued care to be covered. If Medicare denies the claim, you can appeal the decision through the standardized appeals process.
Does Medicare coverage of speech therapy include prescription drugs?
Your doctor may prescribe medication along with speech therapy in the treatment of aphasia. If you are enrolled in a Medicare Prescription Drug Plan, your medications might be covered, although you may have to pay a deductible and a copayment or coinsurance amount. Contact your plan or check your plan’s list of covered prescription drugs to see if the medication is covered. The formulary may change at any time. You will receive notice from your plan when necessary.
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