Medicare will cover speech therapy services when you meet specific requirements. Speech therapy can improve social communication skills, thinking, and understanding, even things like swallowing. If you’ve had a stroke, speech therapy may be a treatment your doctor prescribes. Doctors may recommend speech-language therapy to patients suffering from a head injury or brain tumor. We’ll explain how Medicare covers speech therapy below.
Medicare Guidelines for Speech Therapy
For Part B to cover speech therapy, your doctor must certify that it’s medically necessary and have a treatment plan ready. Medicare 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.
Does Medicare have a Cap or Limit on Speech Therapy Services?
There’s 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. Doctors may request an exception for continuing services, although providers must certify that extra speech therapy is mandatory for recovery.
Your doctor must document in 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 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. 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 prescribes speech therapy services for you at home, Medicare may cover your treatment.
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?
In some cases, medication for speech therapy is prescribed by your doctor. For example, the treatment of aphasia requires a drug for proper treatment. Original Medicare does not cover prescription medications. You’ll need to enroll in a stand-alone Part plan.
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.
Does Medicare Advantage Cover Speech Therapy?
Advantage plans must include coverage that’s as good as Part A and B. However, all 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 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
How to Get Help with Speech Therapy Costs Under Medicare
If you don’t have a supplemental Medicare plan, you could be stuck with high costs for speech therapy. Get help covering those costs with either a Medigap plan or 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.