Augmentative Communication

Medicare Coverage of Speech Generating Devices (SGD)

• Medicare will cover the cost of a SGD if you have Medicare Part B services.

1. You must live in your family home or an assisted living facility
2. Medicare will not cover the cost of a SGD if you are in a hospital, skilled nursing facility, or on hospice.

• Medicare will cover 80% of the allowable cost of the device.  Secondary insurance should pay the remaining 20% but that is not always the case.  If you do not have secondary insurance, you will be responsible for the 20% co-pay.  There are funds available from charitable organizations that may help pay for any deductible or co-pay that insurance does not cover.

• Medicare classifies SGD’s as “durable medical equipment” (DME) and will cover the device under this classification.

• An assessment by a speech-language pathologist is required to document that this device is needed to meet your daily functional communication needs.  80% of the cost of the assessment is covered by Medicare.  The remaining charge can be billed to secondary insurance (if applicable) or will be billed to the client.

• A doctors prescription is required.

• Once the assessment has been completed, appropriate paperwork will be submitted to the vendor of the device.  This process usually takes approximately one to two months.

• If the vendor feels all the paperwork is in order, they will ship the device directly to you. 

• Training on your device can be provided by:
• Vendor—many vendors offer training sessions at no cost.
• Facility—the facility where you received your device can provide training. The cost of the training session is covered by Medicare.
• Chapter—the ALS Association may have resources available for training.

Alisa Brownlee, ATP
March, 2010