Medicare Speech Therapy and Speech Language Pathology Coverage
Written by: Aaron Garcia
Reviewed by: Ed McClane, Licensed Insurance Agent
Original Medicare (Parts A and B) and Medicare Advantage (Part C) offer standard speech therapy benefits.
Medicare Part A helps cover inpatient speech therapy; outpatient services are generally covered by Medicare Part B . Part C offers at least the same benefits as Parts A and B.
To be covered, your speech therapy must be medically necessary.
You can receive speech therapy at home if you meet specific home health care qualifications.
When you need care, the ability to speak and communicate clearly is a huge benefit. Unfortunately, this is also an ability that can be impaired by strokes, traumatic brain injuries, and many other medical issues. Conditions like these can leave you unable to speak or perform other essential functions like swallowing. Often, these skills can be relearned with Speech-Language Therapy.
Does Medicare pay for speech therapy?
Yes — if you need speech therapy, Original Medicare’s Parts A and B can both help cover your care depending on the circumstance. Because Original Medicare covers it, it’s also one of the services that Medicare Advantage (Part C) must provide. So rest assured: If it’s included in your Medicare care plan, speech therapy is generally covered similarly to other medically necessary services.
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Is Speech Therapy Covered by Medicare?
Yes, Medicare will generally cover your speech therapy under a few conditions. First, your doctor will need to determine that it’s medically necessary, and you must have Medicare. From there, a few details will help decide which part of Medicare will help pay for your speech therapy.
If you have Original Medicare Parts A and B and need speech therapy
Original Medicare is made up of Part A and Part B. The two parts provide medical and hospital coverage, respectively. That difference will serve as a good guide for determining whether Part A or B will provide your speech therapy benefits.
Part A: Following severe conditions such as strokes or head injuries, a doctor may determine that you need intensive therapy while recovering as an inpatient. Medicare Part A may cover it if you receive speech therapy at a hospital, skilled nursing facility, or other facilities. A doctor must certify that you need supervised care, among other qualifications.
Part B: The medical insurance portion of Original Medicare, Medicare Part B helps cover outpatient services. In many cases, speech language therapy can be non-intensive and performed in a therapist’s office or even at your own home (more on that below). As with inpatient speech therapy, a doctor will need to certify that it’s medically necessary.
Medicare Advantage (Part C): Medicare Advantage replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. That means Medicare Advantage can help cover both inpatient and outpatient speech therapy. Like Parts A and B, you’ll need a doctor to certify that it’s medically necessary. Unlike Original Medicare, you may need to see a speech therapist in your Part C plan’s provider network.
Does Medicare Cover In-Home Speech Therapy Services?
Medicare offers a range of home healthcare services, which includes speech therapy. As with other services, there are some qualifications you’ll need to meet to qualify for Medicare’s home health benefits in general. They are:
- You’re under the care of a doctor and have a monitored care plan
- Your doctor certifies you need intermittent skilled nursing care or an approved therapy, including physical therapy, speech-language pathology and occupational therapy
- The home health agency performing your care is Medicare-approved
- Your doctor certifies that you’re homebound, which means you have trouble leaving your home without assistance due to an injury or illness, or you’re typically unable to leave your house without significant effort
- You have a face-to-face meeting with your doctor related to your home health condition
In addition to the above, there are a few more qualifications to meet for your therapy to fall under Medicare’s Home Health coverage. Like physical and occupational therapy, speech-language pathology benefits must be “reasonable and necessary.” This will apply to your speech therapy if:
- It is a safe and effective treatment for your specific condition.
- It’s specialized and complex enough to need a qualified therapist to perform or supervise the therapy.
- Your condition needs therapy to repair and improve the functions affected by your illness or injury, or it needs a skilled professional to perform a maintenance program to help prevent your condition from worsening.
- The number of therapy sessions you receive and length and frequency are considered reasonable by Medicare.
Verify with your doctor that your speech therapy meets the eligibility standards above. Discuss your care plan and make sure you know what you’re getting and why. If you receive treatments that Medicare doesn’t cover, you could be stuck paying full price and out of pocket.
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How Much Does Medicare Pay for Speech Therapy?
If you or a loved one needs speech therapy, what you spend for your benefits depends on your Medicare plan and the type of therapy you need. Here are some basic costs to consider for Original Medicare (Parts A and B) and Medicare Advantage (Part C).
Medicare Part A speech therapy costs
The amount you pay for speech therapy begins with your Part A deductible. Your costs toward your deductible begin when you’re admitted to the hospital and end before you reach 60 days of inpatient care. After you meet your Part A deductible, you will pay daily coinsurance rates. Here’s how it works:
- Part A deductible (2022): $1,556
- Days 1 to 60: $0 (after deductible)
- Days 61-90: $389 daily coinsurance
- Days 91 and beyond: $778 per lifetime reserve day. Medicare beneficiaries have 60 of these days to use over their lifetime
- After 60 lifetime reserve days: Beneficiary is responsible for all costs
Medicare Part B speech therapy costs
Medicare care plan speech therapy is typically outpatient, often covered by Part B. You’ll start by paying your monthly premium and Part B deductible ($233 in 2022). After you’ve paid your deductible, Medicare generally covers 80% of your Medicare-approved therapy. You’ll pay the remaining 20%, known as coinsurance.
Medicare Advantage (Part C)
Part C is private insurance and offers at least the same coverage as Parts A and B. As a result, Part C often has different charges and payment structures. One main difference is often copayments; instead of paying a percentage of your care as with coinsurance, Medicare Advantage beneficiaries often have flat-rate copays. If you have Medicare Advantage and need speech therapy, call your insurance company to determine what it costs and how it’s covered.
What is the Medicare rebate for speech therapy?
Whenever you receive a Medicare-approved service from your doctor or another provider, Medicare Parts A and B pay for those services individually. Each medical procedure has a price Medicare has agreed to pay. This is called fee-for-service, and all Original Medicare plans follow this model.
It’s worth noting that Medicare had a cap on the amount of therapy services it would cover in the past. Now, Medicare will continue to cover your therapy as long as your doctor can verify that it’s medically necessary. Once you reach $3,000 combined between speech-pathology and physical therapy services, your care will be subject to a medical review. You can continue to receive speech therapy, but your doctor will need to document that the therapy is reasonable and necessary.