Understanding Medicare and Insurance Coverage for Adult Speech Therapy
- Marigold Speech
- May 2
- 3 min read
Understanding Medicare and Insurance Coverage for Adult Speech Therapy
Janesville, WI
If you or a loved one needs speech therapy as an adult, one of the first questions you may ask is:“Is this covered by Medicare or insurance?”
The good news is—yes, it often is! But understanding the details of coverage can feel overwhelming. At Marigold Speech, we’re here to help you navigate it.
What Types of Speech Therapy Are Covered for Adults?
Speech-language pathologists (SLPs) work with adults on a wide range of challenges, including:
Swallowing difficulties (dysphagia)
Aphasia after a stroke or brain injury
Voice disorders
Cognitive-communication deficits
Speech or fluency issues
Progressive conditions such as Parkinson’s disease or ALS
These are considered medically necessary conditions—a key phrase when it comes to insurance and Medicare reimbursement.
Medicare Coverage for Speech Therapy
Medicare Part B does cover outpatient speech-language therapy services when they are deemed medically necessary and prescribed by a physician or qualified provider.
Here’s what you should know:
You typically pay 20% of the Medicare-approved amount after meeting your yearly deductible.
Services must be provided by an SLP who is Medicare-certified (That’s us!)
Medicare Advantage (Part C) plans may have different rules, so check with your plan directly.
Tip: Always get a doctor referral or written order from your physician before beginning services.
Private Insurance Coverage
Most private insurance plans cover speech therapy for adults when medically necessary—but coverage varies greatly depending on your plan.
Things to check:
Is speech therapy covered for adults (not just pediatrics)?
Is there a limit on the number of sessions per year?
Do you need pre-authorization or a physician referral?
Are specific diagnoses required for coverage?
At Marigold Speech, we’re happy to help you check benefits and understand what your plan covers.
Out-of-Pocket and Self-Pay Options
If you are uninsured or underinsured, don’t worry—we offer flexible private pay rates and payment plans. Our goal is to make high-quality, individualized therapy accessible to those who need it.
You Have the Right to Choose Your Provider
Did you know? Medicare gives you the right to choose where you receive your speech therapy.
You are not required to stay with the provider your doctor or facility recommends—you can see any Medicare-certified speech-language pathologist.
And while convenience might be tempting, we encourage you to ask:
“Who has the experience to truly support my needs?”
At Marigold Speech, our team specializes in adult speech-language therapy—from post-stroke aphasia and dysphagia to Parkinson’s care and cognitive-communication support. We take pride in offering personalized, evidence-based services in a supportive and welcoming environment.
Don't settle for the easiest option—choose the most experienced one.
FAQs: Adult Speech Therapy & Insurance
Q: Do I need a referral for speech therapy?
A: Yes. Medicare and many private insurance plans require a referral or order from a physician. We require it at Marigold Speech.
Q: Does Medicare cover swallowing therapy?A: Yes! Fun fact- Dysphagia therapy is one of the most commonly covered services for adults under Medicare.
Q: Can I still receive therapy if my insurance denies coverage?
A: Absolutely. We offer self-pay options (if applicable) and will help you find the most affordable path forward. If we can’t offer services because you’re out of network, we will help you locate a reliable and vetted practice that can.
Q: Will insurance cover teletherapy for adults?A: Many plans do! During and after COVID, teletherapy coverage expanded significantly. We'll verify your plan's policies.
Let Us Help You Get Started
At Marigold Speech, we believe in removing barriers to care. Whether you're navigating Medicare, private insurance, or self-pay options—we're here to help you every step of the way.
Call us today at 608-728-7774 or contact us here to schedule a consultation. We’ll help you understand your coverage and create a plan that fits your goals and your life.
Comments