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Speech language pathology is the treatment of speech, language, and swallowing-related disorders, such as Aphasia or Dysarthria.
These services are covered under Original Medicare, provided they are deemed medically necessary by your doctor.
You may be able to save on coinsurance payments for these services with a Medicare Advantage plan.
Many health conditions can affect our ability to communicate, leading to slurred speech, difficulty swallowing, and issues with language processing. This can be a frustrating, isolating experience. Fortunately, speech language pathology can help. A speech pathologist can help address any physical issues with speech and swallowing and help you adapt to any neurological changes affecting your speech. Speech and language therapy can help you regain your independence and enjoy doing the things you love, but does Medicare cover speech therapy?
To qualify for Medicare speech therapy, you must get a referral from a doctor who has deemed it medically necessary. This typically means you must be diagnosed with a condition that affects speech, communication, or swallowing. Examples include:
Aphasia: Damage to the brain’s speech and language center. Aphasia’s main symptom is a loss of language comprehension: patients may have difficulty with general communication (including reading, listening, and writing) rather than just speaking.
Apraxia of Speech (AOS): A condition in which the neural pathways responsible for speech are damaged or lost. An individual with AoS can understand language perfectly well and often has no trouble forming sentences in their head. However, their nervous system prevents them from properly speaking or writing the correct words.
Dysarthria: Speech difficulties resulting from nerve or muscle damage to the organs responsible for speech: the lips, tongue, vocal cords, and diaphragm. Patients with dysarthria have no trouble communicating non-verbally but often present with physical difficulties speaking.
These conditions most commonly arise from brain cancer, stroke, or certain degenerative diseases. For instance, dysarthria can be found in individuals with Parkinson’s or multiple sclerosis, while aphasia is a symptom of certain types of dementia. Your doctor will likely refer you to a language speech pathologist if you are diagnosed with any of those conditions.
Speech and language therapy typically falls under Medicare Part B. If you qualify, you pay 20 percent of the Medicare-approved cost after meeting your Part B deductible, with no other limitations. This means that Medicare will never stop covering your therapy, but you’ll continue to pay the 20 percent coinsurance each visit.
Medicare Part A may cover speech and language therapy if performed at a hospital or inpatient facility. However, most speech language pathology sessions are performed on an outpatient basis, with some being performed in the patient’s home or through a certified telehealth app.
As speech and language therapy is covered under Original Medicare, all Medicare Advantage plans must offer it, even if they do not offer any additional benefits. However, the eligibility requirements may vary.
Many plans will require a referral from a doctor before you can see a speech pathologist. The pre-requisites for a referral may be less strict than that of Original Medicare, and specific plans may allow you to seek out a language specialist on your own accord. However, due to the nature of speech language pathology, you likely won’t be seeking treatment unless you’re already showing symptoms, which are invariably the sign of a deeper problem. If you’re experiencing slurred speech, difficulty swallowing, or loss of language comprehension, see your primary care physician first.
The other limitation of Medicare Advantage is the reliance on networks. Like with all private insurance, you pay less if you see an in-network specialist, and out-of-network services may not be covered.
As Medicare Advantage is privately offered, it is subject to the out-of-pocket maximums mandated by the Affordable Care Act. Your insurer must waive any coinsurance fees after a certain point. This applies to all services offered under Medicare Advantage, though the exact out-of-pocket maximum varies depending on your plan. Beyond this, your quality of care will be identical to if you were under Original Medicare, though your cost-sharing burden will likely be lower.
Speech and language therapy is just one of the many unexpected things that Medicare can cover. Want to find out what a Medicare Advantage plan can do for you? Contact one of our licensed insurance agents at (800) 950-0608 to begin your search today.