Medicare Part B covers medically necessary speech-language therapies when provided by qualified healthcare practitioners. Both short- and long-term options may be covered.
Speech therapy involves treating the tongue, mouth, and vocal cords, as well as the muscles and nerves that connect these organs to the brain. Speech therapy is essential for treating and improving a person’s overall communication skills.
Medicare Part B covers speech therapy. Once a person has paid their Part B deductible, Medicare will pay for 80% of subsequent out-of-pocket costs.
This article will look at speech therapy, what it is, why it may be beneficial, and the Medicare coverage available.
Speech-language pathology is a health service that helps individuals regain or improve their
Speech-language pathologists (SLPs), also called speech therapists, provide the treatment.
Speech therapy may help with a speech disorder that develops in childhood. It may also be beneficial for an adult speech condition due to a brain injury or illness, muscular disorder, or stroke.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B helps with the costs associated with medically necessary outpatient therapy services.
A person may be required to pay the Part B deductible. The deductible for Part B is $257, and, once paid, a coinsurance of 20% usually applies to eligible costs.
Medicare does not limit how much it pays for medically necessary outpatient therapy services within a calendar year.
However, if costs exceed a certain amount, a medical report may be required to authorize further treatment.
Eligibility for outpatient therapy
A person may be eligible for Medicare-covered outpatient therapy services if:
- they require skilled therapy services, and a healthcare professional decides that the service may provide safe, effective treatment for the health condition
- a doctor or therapist provides a written plan of care before the person starts their treatment
- the plan of care is updated or changed as needed
If a person meets the requirements for SLP services, Medicare may provide coverage, whether the health condition is temporary or long-term.
Therapy services may be performed in:
- a doctor’s office
- an outpatient hospital setting
- a rehabilitation agency
- a comprehensive outpatient rehabilitation facility
- a public health agency
- a person’s place of residence (via a home health agency)
- a skilled nursing facility
Below is an overview of five of the most common speech-language disorders.
Speech delay
Speech delay occurs when a child is not using age-appropriate communication.
For many disorders that cause a speech delay, early diagnosis and intervention by a qualified speech therapist can make a difference.
Aphasia
Aphasia is a disorder caused by damage to the brain’s speech and language center. Aphasia affects a person’s ability to speak and understand both verbal and written language.
The disorder usually occurs after a head injury or stroke. It may also gradually occur from a degenerative brain disease or as a result of a tumor.
People of any age may experience Aphasia, although speech therapists often treat the disorder in adults who have experienced a stroke or a traumatic brain injury.
A speech therapist may evaluate a person’s:
- reading ability
- writing ability
- general communication
- hearing comprehension
- verbal expression
Also, a speech therapist may help the person improve their language skills and assist in developing coping strategies.
Apraxia of Speech (AOS)
Apraxia occurs when the neural pathway between a person’s brain and their speech function is lost or concealed.
Individuals may know what they want to say or write, but the brain cannot send the correct message. This makes it very difficult for a person to say what they would like, even though their speech muscles are in perfect working order.
AOS in adults is also known as Acquired AOS, and a stroke with resulting damage to the brain could be the cause.
Dysarthria
Symptoms of dysarthria include:
- slowed speech
- slurred speech
- restricted tongue, jaw, or lip movement
- an abnormal rhythm and pitch during speech
- changes in voice quality
- difficulty articulating
- labored speech
Dysarthria may be caused by nerve or muscle damage to the lips, tongue, diaphragm, and vocal cords.
Dysarthria can affect people of all ages. It may start while a baby is in the womb or develop in childhood as a result of muscular dystrophy or cerebral palsy.
The most common causes of Dysarthria in adults are tumors, stroke, and Multiple Sclerosis.
A speech therapist can help a person with Dysarthria by:
- exercising the speech muscles
- breath training and instruction
- helping the person slow down when they speak
Lisping
Lisps are common speech disorders that usually develop in childhood. The disorder is usually noticed when the child makes a “th” sound instead of an “s” sound when speaking.
If a lisp is caused by an irregularity with the teeth, such as an interdental or dentalized lisp, this usually corrects itself as a child grows.
Treatment for lisping includes:
- pronunciation and enunciation coaching
- re-teaching the sound of a word
- practice speaking in front of a mirror
- speech-muscle strengthening such as drinking through a straw
A speech-language pathologist may ensure that the lisp is not confused with another speech disorder like aphasia, apraxia, hearing loss, or irregular development.
Stuttering
People who stutter may get stuck pronouncing certain words or syllables. They may be unable to form the intended syllable at all, make the initial syllable sound repeatedly, or stretch sounds before being able to pronounce the whole word. This can make communication difficult or lead to people avoiding certain words or, indeed, public speaking situations.
There is no single cause of stuttering. It can occur due to family history, brain differences, and environmental factors.
Treatment typically involves speaking with a speech-language therapist. They will assess the root of stuttering and help a person develop methods of managing it. These management solutions may vary between people.
Speech therapy is a health service that helps people regain or improve their voice, speech, language, and swallowing skills. Qualified speech-language therapists perform the treatment. Speech therapy may be required for a child with a speech disorder or for an adult with speech impairment caused by injury or illness.
Medicare Part B helps to pay for medically necessary outpatient speech therapy. Out-of-pocket costs may apply.
If a person meets the requirements for speech therapy, Medicare may temporarily cover either short or long-term treatment.
