Utilizing Medicare Benefits for Speech Therapy

May 15, 2021

Medicare will cover speech therapy services under certain circumstances. If you have had a stroke, injury, or other illness affecting your speech or the ability to swallow, you will be covered. That is the good news. However, with so many aspects of the Medicare rule the details get a little tricky.

To make sure you get the most out of your Medicare benefits, here is what you need to know about coverage when it comes to speech therapy.

Speech therapy defined

Speech therapy is the treatment process that may help you regain the ability to speak, or swallow, after suffering an injury or illness. It can improve both speech and language abilities. Treatment techniques include articulation therapy and language intervention activities.

The length of time that you require speech therapy is based on your age, the severity of your disorder, underlying medication condition(s), and the frequency of the therapy.

Why you would need it

Stroke and traumatic brain injuries are the two most common issues where speech therapy might be required. Both of these can impact a person’s ability to form words and speak clearly. Those suffering from significant hearing loss may also require speech therapy. All of these conditions are often more common in seniors than in other age populations.

  • About 75 percent of strokes happen to people 65 or older and happen to about 800,000 people per year.
  • Adults, 75 and older, have the highest rate of hospitalization due to traumatic brain injuries. These often result from falls.
  • One in three people between 65 and 74 experience hearing loss, and almost half of those over 75 have difficulty hearing.

Specific conditions 

Both stroke and brain disorders can lead to aphasia. This condition affects a person’s ability to speak and understand others. It can also impact a person’ ability to read and write. Another condition that stroke victims and those with brain injuries can face is cognitive-communication disorders. This can include difficulty in both speaking and listening.

For those requiring speech therapy due to hearing loss, they may suffer from a receptive language disorder. This is where they will have trouble understanding and processing what others say. 

Each of these conditions make it medically necessary to receive speech therapy, which is the only way to get Medicare coverage for this specific type of treatment. As long as you have documentation from a medical professional, saying you require speech therapy, Medicare benefits kick in.

A breakdown of speech therapy coverage

Each part of Medicare pays for speech therapy in a different way. What parts you have in your own plan will dictate where and when you have coverage.

  • Part A will cover speech therapy if it’s needed while you’re in the hospital or at an inpatient rehabilitation facility. 
  • Part B will address coverage for speech therapy while in a speech therapist’s office, at an outpatient facility, or in the hospital on an outpatient basis.

If you’ve opted for Part C plans in place of Part A and B, you’ll still get at least the same level of coverage, but you may have to get a referral from your primary care physician before you can see a speech therapist. You may also have limitations on using only in-network doctors.

A breakdown of speech therapy costs

How much you end up paying, out-of-pocket, for speech therapy varies based on a few factors — the type of therapy, where you receive it, and how long you need it.

Actual dollar amounts are based on whether or not you’ve already met your deductible for the specific Part of Medicare associated with the treatment. If you’re receiving speech therapy while in the hospital, the cost goes up based on the number of days you’ve been in the facility. You’ll typically see a cost increase at day 60, and again at day 90.

If you’re receiving speech therapy at a specialist’s, or as an outpatient, after you meet the deductible, you’re responsible for paying 20 percent of the Medicare-approved amount for the services. There’s no limit to the amount of speech therapy you can receive in a single year as long as you have documentation that it’s medically necessary.

Do you have enough coverage?To ensure you have the right Medicare coverage to include speech therapy services, it’s best to work with an experienced health insurance agent. At Health Solutions Direct, we take a personalized approach to each client’s insurance needs. From there, we carefully explain the subtleties of Medicare as we customize the best plan options for you. With a transparent process and attention to detail, we can help get you the right coverage for your specific medical needs. To learn more, contact us today.

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