Medicare can cover Speech Therapy when you meet specific requirements. Speech therapy can improve social communication skills, thinking, and understanding, even things like swallowing.
The National Institute on Deafness and Other Communication Disorders estimates 6 to 8 million people have language impairment nationwide. Adults may suffer from these disorders due to dementia, head injury, stroke, as well as brain tumors.
If you have had a stroke, speech therapy may be a service your doctor prescribes to you.
About 7 million people across the country suffer from language impairment according to the National Institute on Deafness and Other Communication Disorders.
Language disorders in adults may be the result of a condition or stroke. Head injuries and brain tumors may also cause language impairment.
Doctors may recommend speech-language therapy to patients suffering from these disorders.
Speech-Language Pathologist provides necessary therapy. Patients with Medicare should understand coverage speech therapy.
Does Medicare Cover Speech Therapy
For Part B to cover speech therapy, your doctor must certify that you need speech therapy. To get these services with coverage by Medicare, you must first have a treatment plan; this treatment plan must be by your doctor.
Those with Part C trying to get coverage for speech therapy will have coverage at least as good as Medicare.
Check with your agent to determine what or how much your Medicare Advantage plan covers; Also, for speech therapy, be sure to ask about your copayment or coinsurance.
What is Speech Therapy
Speech and language therapy is often from a therapist specializing in speech and language. Therapists such as these are Speech-Language Pathologist.
Speech therapy is speech-language pathology; this therapy may aid in your ability to regain language and communication skills.
According to the American Speech-Language and Hearing Association (ASHA), speech therapy includes:
- 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 with 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
The National Institutes of Health noted that speech therapy improves the ability to communicate. Speech therapy may restore language skills, and find alternative ways to communicate other than verbally.
Therapy of this nature might start with a visit with a speech pathologist to create a treatment plan for your specific situation.
Medicare Coverage for Speech-Language Pathology Services
Pathologists giving service can properly assess, diagnose, and treat patients. Conditions that impair swallowing, language, and communication disorders in both adults and children.
Speech-language therapists should aim to prevent diseases from prone patients. Therapy treatments include rehab services, speech alternative techniques, and counseling services.
The American Speech-Language and Hearing Association (ASHA) requires these experts to earn a master’s degree and complete the hours of clinical experience. Then, after passing a national exam, specialists may provide therapy to patients.
Speech-Language Therapy Services
The National Stroke Association classifies language impairments that affect the ability to vocalize thoughts, understand others when they talk, the ability to read and write as Aphasia.
According to ASHA, the most common cause of aphasia is having a stroke. However, other potential causes could include brain trauma or injury, neurological conditions like dementia, and brain tumors.
Speech therapy helps many patients recover from aphasia. Although, therapy type depends on how severe the condition.
Some therapy types include:
- Group speech and language therapy
- Visual speech perception treatments – helps the patient associate words with pictures
- Art therapy
- Melodic intonation therapy – helps individuals “sing” the words they have difficulty speaking
Doctors may prescribe medications to help treat speech pathology. Also, treatment may include at-home practice. Patients may play word games, cook from a new recipe, sing or read aloud, and practice writing exercises.
When would you need Speech Therapy
You’re not alone if you’re someone that survived a stroke or is a caregiver of someone that had a stroke. Also, about 800,000 people nationwide have strokes every year.
Difficulty with speaking after someone has had a stroke is widespread, according to the Centers for Disease Control. Although, the diagnosis of aphasia is possible if the stroke damages parts of the brain.
To further treat your aphasia, your doctor may suggest you go to speech therapy. Of course, strokes aren’t the only cause of aphasia as it can come from brain tumors or head injuries.
Your doctor may also recommend speech therapy if you have difficulty swallowing.
Part B might cover some of the costs of speech and language therapy; however, if you’re a Medicare Advantage Plan beneficiary, your plan should help cover Medicare-approved speech therapy costs just the same.
If your doctor orders speech therapy and certifies it’s important, Part A or Part B may cover costs. Those with speech therapy as part of home health care, more requirements might need to be met.
Does Medicare Coverage of Speech Therapy have a Cap or Limit
Those with a Part B plan, there might be a limit on the amount Part B will pay for speech therapy services each year. Once amounts rise to $3,000, Medicare may choose to review a patient’s case to ensure continuing treatment is essential.
Many beneficiaries reach the annual cap before treatment is complete. Doctors may request an exception for continuing services, although providers must certify that extra speech therapy is mandatory for recovery.
In this case, doctors must document in a patient’s medical record, declaring the medical need for more therapy. If Medicare doesn’t find enough proof to support the exception claims, they may deny treatment until the end of the calendar year.
If you reach your cap amount, you may be responsible for paying the full cost of services. When the doctor says you need to continue speech therapy and your cap amount is approaching, the doctor can notify Medicare.
After Medicare accepts the exception claim, Part B continues to pay 80% of allowable charges. Beneficiaries are responsible for the other 20%.
If Medicare denies this claim for any reason, you have the option to appeal the decision through the appeals process.
Will Medicare cover Speech Therapy Services at Home
If your doctor refers speech therapy services for you at home, Part A may cover your treatment.
To qualify, you must meet these requirements:
- You must be under a doctor’s care, and they must write a plan that includes speech pathology treatment.
- The doctor states that with speech and language therapy, your condition will improve within a reasonable timeframe
- Your doctor must certify that you’re homebound
- All agencies used to provide speech pathology services, and treatments must be Medicare-approved agencies
If you qualify for home speech and language services/therapy, you typically have 0 out-of-pocket costs for those services.
Can Medicare Cover Speech Therapy Prescription Drugs
In some cases, medication, along with speech therapy, is a requirement from your doctor. For example, the treatment of aphasia requires a drug for proper treatment.
You can always resort back to your formulary to check if your drug is under your plan. Your formulary can change at any time, but you will get a notice from your policy before that happens.
To find a policy that helps cover the gaps in Medicare, call us at the phone number above. Don’t have time to call? Fill out the online rate form and discover your best coverage today!
Medicare Advantage Coverage for Speech-Language Pathology Services
Advantage plans are Part C; they must offer coverage as good as Part A and B. Although beneficiaries should contact their Agent to determine coverage.
However, all Advantage plans offer different benefits at different rates. Before therapy, recipients should contact healthcare plans directly to ask about coverage.
Agents provide information about what and how much a plan covers while answering all Medicare questions.
Depending on the level of care, these costs may become too costly to afford. Working with an agent can ensure recipients choose the right plan.
Choosing the right policy can help pay for gaps in Medicare coverage. We’re here to help! Give us a call at the phone number above.
If you don’t have time to call, don’t worry. Just fill out the online rate form and find the best option today!