Medicare may cover speech therapy services under parts A, B, or C, but they must be medically necessary and may require using an in-network provider. Medicare no longer caps the amount it covers for speech or other therapy services within a year.
Medicare covers speech therapy services if you’ve had a stroke, injury, or other illness that affects your speech or ability to swallow. How Medicare pays for these services depends on where you go for therapy and why you need it.
This article reviews the parts of Medicare that pay for speech therapy and explains how to know whether you’re eligible for coverage.
Medicare divides its services into parts A, B, C, and D. Each part pays for different types of services.
Here are some examples of when different parts of Medicare would cover speech therapy.
Part A coverage
Medicare Part A pays for medical treatments received at a hospital or inpatient care center. It may also cover the costs of speech therapy if it’s needed during a stay at a hospital or inpatient rehabilitation facility.
For example, if you have a stroke, you may require an inpatient hospital stay to treat the immediate effects of the stroke.
During this time, a speech-language pathologist may evaluate your ability to communicate or determine if you have problems swallowing. Your doctor can then coordinate a treatment plan.
Following your inpatient hospital stay, you may benefit from rehabilitation services. These could include therapies to regain strength and function on one side of your body and to continue improving communication and swallowing skills through speech therapy.
Part B coverage
Medicare Part B pays for medical costs such as:
- doctor’s visits
- outpatient therapies
- durable medical equipment
Part B may help pay for speech therapy when you receive it in an outpatient setting, like:
- a speech therapist’s office
- an outpatient therapy facility
- a hospital on an outpatient basis
Does Medicare Advantage cover speech therapy?
Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B), where a private insurance company provides your Medicare benefits.
Medicare requires Part C plans to cover at least the same costs and coverage as Original Medicare. This means Medicare Advantage would cover both inpatient and outpatient speech therapy.
However, the insurance company providing your Part C plan may require you to get a referral from your primary care physician before you see a speech therapist or require you to use in-network providers.
To qualify for speech therapy coverage, you must first be enrolled in Medicare. You will typically do this when you turn 65 years old or if you have a qualifying disability or medical condition, such as end stage renal disease or amyotrophic lateral sclerosis.
You also must have documentation from a physician stating that speech therapy is medically necessary for your situation. Your doctor may recommend an initial therapy course and then restate that ongoing therapy is medically necessary later.
In addition, the speech therapist and facility you visit must accept Medicare-approved costs. To find out if a potential provider accepts Medicare, check Medicare’s provider search tool.
Medicare and Medicare Advantage plans negotiate with speech therapists to set costs. The amount you’re charged (and how much you pay) depends on:
- the type of speech therapy
- the facility where you receive therapy
- how long you receive these services
What you may pay will also depend on which part of Medicare covers these services. Next, we’ll examine some of the costs associated with each part.
Part A costs
Under Part A, when you enter a hospital or skilled nursing facility, you begin a benefit period. During each benefit period, you are responsible for a $1,632 deductible.
After you meet the deductible, you’ll pay the following coinsurance costs in 2024 based on how many days you’ve been in the facility:
- Days 1 through 60: $0 coinsurance
- Days 61 through 90: $408 daily coinsurance
- Day 91 and beyond (up to 60 lifetime reserve days): $816 daily coinsurance
After you’ve used all of your lifetime reserve days, you’ll be responsible for all medical costs. You begin a new benefit period when you haven’t been in the hospital or skilled nursing facility for 60 consecutive days.
Part B costs
Under Part B, you must first meet your deductible, which is $240 for 2024. Once you’ve met your deductible, you’ll be responsible for paying 20 percent of the Medicare-approved amount for your speech therapy services.
It’s important to note that Medicare used to limit how much it would pay for speech therapy services in a calendar year. However, it no longer limits your amount of speech or physical therapy services, as long as a qualified healthcare professional states that the services are medically necessary.
Part C costs
Under Part C or Medicare Advantage, you’ll usually pay a copayment or coinsurance cost when you see a speech therapist. You typically pay less for a provider in your insurance company’s network.
Many Medicare Part C plans have an out-of-pocket spending limit. If you reach this limit before the end of the calendar year, your plan should cover your costs.
How many speech therapy visits does Medicare cover?
Once you reach your Part B, Medicare will cover 80% of the cost of any speech therapy you need without a cap on the number of sessions.
When it comes to Part A, the number of sessions you have will depend on how long you stay hospitalized, which Medicare should cover under the costs listed above.
Medigap costs
If you have Original Medicare (Parts A and B), you can purchase a Medicare supplement (Medigap) plan. These plans have a premium but can help cover your ongoing out-of-pocket costs from Medicare.
What are the Medicare billing codes for speech therapy?
Billing codes are also called CPT codes. The American Speech-Language-Hearing Association (ASHA) provides a list of speech-therapy-related CPT codes that you can use to verify coverage. That said, these may change from time to time.
Does Medicare cover speech therapy for patients with dysphagia?
Speech therapy, or speech language pathology, helps people recover the ability to speak and swallow after an injury or illness. Dysphagia (difficulty swallowing) should, therefore, be covered. You may also need speech therapy after a stroke or brain injury, head or neck surgery, or other prolonged illness. People with profound hearing loss may also benefit from this treatment.
Does Medicaid cover speech therapy?
Medicaid may cover speech therapy, but this may vary from state to state, as speech therapy isn’t a mandatory service under Medicaid rules.
Medicare covers medically necessary speech therapy services. There’s no longer a limit on how long you can receive these services in a calendar year.
Speech therapy can help improve necessary skills such as speech and language abilities and swallowing.