Does Medicare cover speech-language pathology services?

Published by Medicare Made Clear®

How does Medicare cover speech-language pathology?

According to the National Institute of Neurological Disorders and Stroke, more than 700,000 people suffer from a stroke annually in the United States. Additionally, one in four stroke survivors suffer from a comprehension or communication disorder, also known as aphasia, and will require rehabilitation from a speech-language pathologist.

A speech-language pathologist will provide services that include the evaluation of and treatment to help someone regain and strengthen or maintain current function or slow decline of speech and language skills. A speech-language pathologist may also help with voice issues, as well as cognitive function and swallowing problems.

Medicare will cover medically necessary speech-language pathologist services

Medicare Part B may help pay for outpatient speech-language pathology services if they are deemed medically necessary, and if your doctor or health care provider certifies you need them. If you have a Medicare Advantage plan, you’ll need to check with your plan provider to see how these services may or may not be covered and what they will cost.

How much will Medicare pay for speech-language pathology services?

In most cases, speech-language pathology services and other forms of outpatient therapy like occupational therapy or physical therapy) will be covered by Medicare Part B, which will pay 80% of the Medicare-approved amount. For the full 80% coverage to be applied, you will need a referral from your primary care provider and the provider must accept Medicare assignment. In most cases, you will be responsible for 20% of the cost after meeting the Part B deductible. However, you should always talk to your healthcare provider beforehand to confirm how much your treatment will cost prior to your appointment. The amount you owe may depend on several factors such as other insurance coverage, the type of facility, where you get tested/receive service, how much your doctor charges, and whether your provider accepts Medicare assignment.

In past years, Medicare had limits as to how much outpatient therapy they would pay for. As of 2019, those limits have been removed.

Your doctor may recommend services more often than Medicare covers, or they may recommend services that Original Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs out of pocket. A Medicare Advantage (Part C) plan could help cover some of the additional costs.

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