Speech Therapy Coverage with Medicare in Illinois

In most cases, you will be responsible for 20% of the Medicare-approved amount for your speech therapy services after you meet your Part B deductible. Medicare will generally cover the remaining 80% as long as your evaluation and treatment are considered medically necessary. This typically means:

• A doctor has determined that speech therapy can help you make meaningful progress.
• Therapy is expected to bring noticeable improvement within a reasonable time.
• Services are provided by a licensed speech-language pathologist.
• Treatment follows a written plan of care approved by your physician.

Common Conditions Covered

Medicare covers speech therapy for a variety of conditions, including:

• Speech and language difficulties due to stroke, injury, or neurological diseases
• Swallowing and feeding difficulties
• Voice disorders related to anatomical or neurological conditions, injury, or surgery
• Fluency disorders that impair communication

Important Coverage Considerations

• Medicare no longer limits how much it will pay for your medically necessary outpatient speech-language pathology services in one calendar year.
• Medicare now covers speech therapy that maintains an individual’s current abilities as long as skilled therapy is required to prevent or slow decline due to a chronic condition.
• Medicare will likely not cover therapies not related to a medical diagnosis, such as accent modification, voice coaching, or general communication skills otherwise.

Getting started with speech therapy can feel overwhelming, but you don’t have to navigate it alone. At Verse Therapy, we’re here to help you through each step and make the process as seamless as possible.

How We Support You:

1. We Verify Your Benefits – We’ll check your Medicare coverage for speech therapy services and explain what will be covered.
2. We Handle Referrals & Authorizations – If Medicare asks for a physician’s referral or prior authorization, we’ll help coordinate with your doctor and Medicare to get the approvals needed.
3. We Match You with the Right Provider – Our team will connect you with a licensed speech therapist who fits your needs and is enrolled in Medicare.
4. We Schedule Your First Appointment – Once everything is in place, we’ll help you book your initial evaluation and get started on your therapy journey with ease.

Navigating insurance can be confusing, so here’s a quick breakdown of key terms to help you understand how they may impact your care at Verse.

• In-Network vs. Out-of-Network: When a provider is in-network with Medicare, they are under contract with Medicare to provide discounted services to its members. If a provider is out-of-network with Medicare, Medicare may still cover some costs for services, but you may be responsible for more.
• Copay: This is the fixed amount you pay for each visit. If your copay for speech therapy is $30, for example, you pay that amount for each session, and Medicare covers the rest.
• Deductible: This is the amount you must pay out of pocket before Medicare starts covering costs. If your deductible is $500, for example, you’ll need to pay that amount for medical services (including those outside of Verse!) before your insurance starts contributing.
• Coinsurance: After meeting your deductible, you may still be responsible for a percentage of the cost. For example, if your coinsurance is 20%, Medicare will cover 80% of the cost of therapy, and you will owe the remaining 20%.
• Out-of-Pocket Maximum: This is the most you’ll have to pay for covered medical services in a plan year. Once you reach this limit, Medicare will cover 100% of approved services.