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Does Medicare Cover Speech Therapy?

Medicare will cover speech therapy services if you meet specific requirements set by the Center for Medicare and Medicaid Services (CMS). Medicare speech therapy benefits are only available when it is medically necessary. However, it’s essential to understand which types of Medicare coverage offer such benefits.

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Speech therapy can improve social communication skills, thinking, understanding, and even things like swallowing. If you’ve suffered a stroke, speech therapy may be the treatment your doctor prescribes. Doctors may also recommend speech-language therapy to patients suffering from a head injury or brain tumor.

Below, we’ll explain how Medicare covers speech therapy and how you can benefit from these services.

Medicare Guidelines for Speech Therapy

Medicare speech therapy guidelines dictate that a doctor must certify a patient’s therapy as medically necessary and have a treatment plan ready. Medicare Part B will cover 80% of the cost. You’ll be responsible for the remaining 20% unless you have a Medicare Supplement plan to cover the coinsurance.

If you require rehab for a related issue, Medicare Part A can also help. Furthermore, Medicare Advantage may also provide benefits, but these can vary from plan to plan and carrier to carrier.

Remember, Original Medicare benefits come from a federal government-run program, whereas private carriers provide Medigap and Medicare Advantage coverage.

Does Original Medicare Cover Speech Therapy?

Original Medicare will cover speech therapy through your Medicare Part B benefits. Unfortunately, Medicare Part A does not cover speech therapy, as it is designed to cover hospital-related expenses for inpatient care, skilled nursing facility care, hospice care, and home healthcare.

Medicare Part B will cover speech therapy if it’s medically necessary. Part B provides benefits for outpatient care, including medical services and doctors’ appointments. Therefore, visiting an SLP because of medically essential healthcare is covered by your coverage.

In addition to Medicare Part B, Medicare Advantage or Medicare Supplement (Medigap) plans are available to can help cover the costs associated with speech-language pathologist (SLP) services.

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Does Medicare Cover Speech Therapy for Patients With Dysphagia?

Yes, Medicare will provide coverage for patients with dysphagia. According to the Centers for Medicare & Medicaid Services (CMS), “speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability.” Dysphagia is the medical term describing difficulty swallowing, and Medicare beneficiaries receiving treatment for this medical condition are covered.

Does Medicare Have a Cap or Limit on Speech Therapy Services?

Yes, there’s a limit on the amount Medicare Part B will pay for speech therapy services each year. Once amounts, combined with physical therapy costs, rise to a certain amount, Medicare may choose to review a patient’s case to ensure continuing treatment is essential.

Doctors may request an exception for continuing services, although providers must certify that extra speech therapy is mandatory for recovery. Known as a “therapy cap,” the limit can change yearly. The Medicare speech therapy cap in 2024 is $2,230.

Your doctor must document your medical records, declaring the medical need for more therapy. If Medicare doesn’t find enough proof to support the additional therapy, they may deny treatment until the end of the calendar year.

If you reach your cap amount, you may be responsible for paying the total cost of services. When the doctor says you need to continue speech therapy and your cap amount is approaching, the doctor can notify Medicare. If your Medicare speech therapy benefits are denied by the program denying this claim for any reason, you can appeal the decision through the appeals process.

Will Medicare Cover Speech Therapy Services at Home?

Medicare may cover your treatment if your doctor prescribes speech therapy services for you at home.

To qualify, you must meet these requirements:

  • Your doctor must certify that you’re homebound
  • All agencies used to provide speech pathology services, and treatments must be Medicare-approved agencies

Will Medicare Cover Prescriptions for Speech Therapy?

Yes, Medicare Part D covers prescriptions for speech therapy in some cases. Prescription medication is an option for speech therapy. For example, such medications as dopamine agonists and amphetamines may be included in a treatment plan for acute or chronic aphasia. But to receive Medicare coverage, your doctor must prescribe any medication or service for your speech therapy. Furthermore, you’ll need to be sure that your plan’s formulary covers your medication.

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Does Medicare Advantage Cover Speech Therapy?

Yes, Medicare Advantage plans can cover speech therapy, but you’ll want to be sure your specific plan will. While Medicare Advantage plans must include coverage that’s as good as Medicare Part A and Part B, all Medicare Advantage plans offer different benefits at different rates. Before therapy, recipients should contact their carrier directly to ask about coverage.

Speech therapy may include:

  • Practicing conversational speech and how to utilize cues to help remember/recognize words
  • Assessment, diagnosis, and treatment for those that have difficulty swallowing, language, and communication issues for both children and adults
  • Helping those who have trouble swallowing – finding out what the problem is and working with you, in a case-by-case manner, to help improve how you eat and drink correctly and comfortably.
  • “Re-learning” communication skills
  • Rehabilitation services for those who’ve lost their hearing
  • Augmentative and alternative communication (AAC) techniques are taught to people who are unable to express themselves otherwise through speech

Medicare Supplement and Speech Therapy

Medigap coverage provides benefits for the same services as Original Medicare. As supplemental coverage, your Medicare Supplement plan picks up according to the plan you enroll in by covering the expenses left over after using your Original Medicare benefits. Therefore, Medicare-approved healthcare for medically necessary speech therapy is covered.

This is an excellent option for many beneficiaries as Medigap plans can provide additional coverage through affordable premiums. Ultimately, this helps you lower healthcare costs according to your needs. By speaking with a licensed Medicare agent, you can find the right benefits for your healthcare and budget to help cover speech therapy and many other medical needs.

How to Get Help with Medicare Speech Therapy Coverage

Medicare reimbursement for speech therapy is available, but it’s important to enroll in the right coverage to help keep your healthcare costs low. If you don’t have a supplemental Medicare plan, you could be stuck with high prices for speech therapy.

Help is available through either a Medigap plan or a Medicare Advantage plan. Start by speaking to an agent to see what options are available in your area. If you don’t have time to call, don’t worry. Just fill out the online rate form and see rates in your area now for Medicare speech therapy coverage.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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