If you are having any physical issues where your speech is impacted, it’s difficult to know without prior experience if Medicare will pay for those associated costs. Speech-language pathology (also known as speech therapy) issues at this age can be a symptom of other medical issues, so keep reading to see how Medicare will cover these.
Medicare speech therapy coverage
The short answer is that, yes, Medicare does cover speech-language pathology. The treatment is more commonly known as speech therapy or speech therapy services. Suppose you suffer an accident that physically damages your throat, vocal cords, or parts of the brain responsible for speech and swallowing. In that case, you may require speech therapy to maintain your quality of life.
Speech therapy often includes:
- Assessing and diagnosing children and adults for difficulty swallowing, speaking language, and communication problems
- Practicing conversational speech
- Using certain cues to remember or recognize words
- Relearning lost communication skills
- Rehab services to recover hearing loss
- Augmentative and alternative communication for those who have lost the ability to express themselves via speech
Original Medicare costs for speech therapy
Most speech therapy is performed at outpatient facilities by specialists. Your Medicare Part B benefits will help pay for most of this care. This means that after you pay your annual Part B deductible of $240, you’ll be responsible for your 20% coinsurance cost of the Medicare-approved amount of your treatment.
However, you may need speech therapy due to an acute problem like a stroke. Your Medicare Part A hospital benefits will help pay for any speech therapy you receive in the hospital. If that visit starts a new benefit period, you could be charged:
- $1,632 for your Part A deductible
- On day 61, [GCBB#part-a-inpatient-coinsurance-days-61-90] per day in coinsurance costs
- If you stay for more than 100 days, you will have to pay for your speech therapy and other hospital costs 100% out of pocket
Speech therapy limits and spending caps
Original Medicare used to put caps and limits on how much specialist care (like speech therapy) an individual could receive. Thankfully, those caps were removed in 2018.
Today, you can get unlimited speech therapy services as long as your doctor can prove they are medically necessary.
There is a spending threshold of $2,150 that you will have to hit before Medicare starts asking questions about your treatment. You can still receive therapy, but your healthcare provider must use different codes. This helps the CMS know that you have passed your spending limit. After you pass that limit, all future therapy must be strictly medically necessary. But it may become progressively harder to prove necessity over time. You are more likely to get your claims denied once you pass this spending limit.
Additional speech therapy services
Under special circumstances, you can get Medicare to pay for a specialist to visit your home if your doctor thinks it’s medically necessary. This happens if your doctor believes traveling could be dangerous or if you are homebound. However, you must ensure that your therapy is from a Medicare-approved specialist.
Some beneficiaries may require prescription drugs in addition to therapy. You’ll have to enroll in a Medicare Part D prescription drug plan. Alternatively, a Medicare Advantage plan which covers prescription drugs works, too. These drugs must also be approved as medically necessary by your doctor.
Medicare Advantage and speech therapy services
By law, your Medicare Advantage provider must offer you the same benefits as Medicare. But they can also do things a little differently. Some of those differences may include lowering your co-pays or eliminating coinsurance costs. Or they may keep costs down by limiting your appointments and spending.
There’s also the issue of medical networks. There are limitations on your choices of doctors and facilities. But these limitations will also keep your costs down, so there is an advantage to that.
Medicare Supplement insurance and speech therapy
Which Medigap plans will reduce your speech therapy costs the most? Any plan covers 100% of your Part B coinsurance or copayment costs. Those plans include:
Does Medicare cover speech therapy for patients with dysphagia?
Since dysphagia is a communication disability, Medicare covers speech therapy to help with the ailment.
What are some of the concerns regarding Medicare reimbursement of speech-language pathology services?
Unique to speech therapy, one of the main concerns is that Medicare will not cover Speech Pathology Assistants to provide service. So it’s imperative to ensure you know the qualifications of the person granting you an appointment to avoid an unexpected bill.
Does Medicare cover swallow therapy?
If the service has a doctor saying it is medically necessary, Medicare will foot some of the bills for swallow therapy.
Receive assistance for Medicare coverage for speech therapy
We understand finding a Medicare plan that meets your needs can be hard. This is especially true if you need speech therapy. But we are here to help you feel less discouraged and more hopeful.
Our licensed insurance agents can tell you anything you need to know about Medicare Supplemental plans available to you. The agents can also match you with the best plan for your needs.
For assistance in learning more, give us a call today. Or complete our online rate form to get the best rates in your area now.
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