Does Medicare Cover Stuttering?

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Aphasia is the loss of ability to understand or express speech. One of the most common forms of aphasia is stuttering. Stuttering affects more than 68 million people in the world, and more than 3 million of those people are Americans.

Stuttering causes one to have disruptions in their speech. Stuttering can accompany things like strokes, dementia, and even brain tumors. However, the exact reason as to why people stutter is unknown.

Whether you have stuttered all your life, or you have recently developed the disorder, speech-language pathology may be in your future.

Will Medicare Cover My Speech Therapy?

Speech-language pathology (SLP), or more commonly known as speech therapy, is when a therapist assesses, diagnoses, and treats disorders that affect someone’s communication and language skills. Because dementia and strokes are common in seniors, speech therapists have many senior patients.

Medicare understands this and has prepared coverage guidelines for speech therapy. In most instances, Medicare will cover at least part of your therapy. Depending on your circumstance, Medicare might even cover all of your costs for speech therapy for a short period of time.

Your coverage will come from Original Medicare. Original Medicare consists of two parts, Part A and Part B. Each part was made to ensure different aspects of the beneficiary’s medical needs.

Below, we explain how each part might cover your speech therapy.

What Does Part A Cover?

There are a few different ways you can receive speech therapy. One way is being referred to receive services at home. In this case, your treatment will likely be covered under Part A.

In order to qualify for at home services, you must meet certain requirements. The main requirements are:

  • You must be homebound certified by your doctor
  • The care plan that your doctor provides must include the necessity of speech therapy
  • Your doctor thinks that your disorder will improve in a timely manner
  • You must use a Medicare certified agency

Another way that Part A will cover your therapy, is if you are sent to a Skilled Nursing Facility (SNF). Again, you must qualify to become a patient at an SNF. Find out here if you qualify.

Part A insures you for the first 100 days in an SNF. During those first 100 days, you will begin with a $0 copay for 20 days. Then your copay becomes $167.50 per day until day 100. If you remain in an SNF beyond that, your speech therapy will be covered by Part B.

What Does Part B Cover?

Another way you might receive your speech therapy is in an outpatient setting. An outpatient setting can be at a doctor’s office, a speech therapist’s office, or a Comprehensive Outpatient Rehabilitation Facility (CORF). If you receive your therapy at one of these locations, Part B will cover it.

Speech therapy coverage under Part B is just like anything else that Part B covers. After the annual deductible has been met, Medicare Part B will cover 80% of the costs for items that are medically necessary, and you will be responsible for the rest. Beneficiaries can purchase Medigap insurance to help them cover Part A and B deductibles and that other 20%.

In years past, Medicare has had a preset hard spending cap on therapy services. Once the total spending amount reached $2,010, Part B would stop paying for therapy for that calendar year.  However, with the recent passage of the Bipartisan Budget Act, Congress eliminated the hard cap. Going forward, Medicare has set a threshold at the same dollar amount, $2010, but exceptions can be made when more therapy is documented as medically necessary.

Then when spending reaches $3000, CMS may conduct a targeted medical review to confirm medical necessity. If Medicare declines additional therapy, then your therapist is required to give you a written notice that Medicare will no longer pay for the therapy. This is known as an Advance Beneficiary Notice of Noncoverage (ABN).

Additional Need to Know Information

You can also receive coverage for speech therapy under a Medicare Advantage plan. Because Medicare Advantage plans include Original Medicare, speech therapy is covered very similarly. Each Advantage plan is different in what they charge for copays and deductibles, so be sure to check with your plan to see how your therapy may be covered.

Some doctors may prescribe medications to assist your speech therapy. In this case, it’s recommended you have a Part D plan to cover these prescriptions. Drug plans have formularies that explain which medications are covered. Check your formulary to see if your prescriptions are covered by that specific plan.

 

Danielle Roberts is a Medicare insurance expert. You can learn more about what Medicare covers here: https://boomerbenefits.com.

 

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