Medicare can cover Speech Therapy when certain requirements are met. Speech therapy can improve social communication skills, thinking, and understanding, even things like swallowing.
The National Institute on Deafness and Other Communication Disorders estimate 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 or healthcare provider prescribes to you.
Does Medicare Cover Speech Therapy
For Medicare Part B to cover speech therapy, your doctor must certify that you need speech therapy. To receive 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 receive coverage for speech therapy will have coverage at least as good as Medicare.
Check with your Medicare 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 provided by a therapist specializing in speech and language. Therapists such as these are Speech-Language Pathologist (SLP).
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 swallow 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.
When would you need Speech Therapy
You’re not alone if you’re someone who has survived a stroke or is a caregiver of someone who has had a stroke. Additionally, about 800,000 people nationwide have strokes every year.
Difficulty with speaking after someone has had a stroke is very common, according to the Centers for Disease Control. Although, diagnosis of aphasia is possible if the stroke damages parts of the brain according to the National Institute of Health.
To further treat your aphasia, your doctor or healthcare provider may suggest you go to speech therapy. Of course, strokes are not the only cause of aphasia as brain tumors or other head injuries can cause this as well. Your doctor may also recommend speech therapy if you have difficulty swallowing.
Medicare 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 medically necessary, 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 Medicare Part B plan, there might be a limit on the amount Part B will pay for speech therapy services each year.
Once the annual Medicare Part B deductible is met, Medicare will typically cover up to 80% of the amount for each service; the remaining 20% is what you will be responsible for paying. If you reach your cap amount, you may be responsible to pay the full cost of services.
When the doctor notes that it’s medically necessary for you to continue speech therapy and you are coming close to your cap amount, your doctor can then notify Medicare of the medically necessary services.
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, Medicare Part A may cover your treatment.
To qualify for coverage certain requirements must be met:
- You must be under a doctors 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 prescription for proper treatment.
You can always resort back to your formulary to check if your prescription is under your plan. Your formulary can change at any time, but you will receive a notice from your plan when/before that happens.
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