Funding Programs
Speech Generating Devices (SGDs) are covered by almost all major health-benefit funding programs in the United States.
The "Four-Question Test" for Coverage
To determine if equipment is subject to payment, most programs apply this standard test:
- Is the person a beneficiary or recipient of the program?
- Is the equipment "covered" within a benefit category (e.g., Durable Medical Equipment)?
- Is the item "medically necessary"?
- Is the item subject to any specific exclusions?
1. Medicare
Medicare is the largest single purchaser of SGDs. It covers SGDs as Durable Medical Equipment (DME). The current coverage criteria were adopted in 2001 after an extensive 18-month investigation.
2. Medicaid
By 2000, all state Medicaid programs approved SGD funding. Most cover SGDs as DME, though some classify them as prosthetic devices.
3. Private Insurance
More than 1,000 different insurers and health plans have paid for SGDs. They are routinely covered under DME or Prosthetic Device benefits.
A 2006 actuarial report by Milliman, Inc. found the cost of covering SGDs to be "de minimis"—averaging at most 2 cents per member per month.
Other Funding Systems
- Tricare: Covers SGDs as prosthetic devices.
- VA: Covers SGDs as prosthetic devices for veterans.
- Special Education: Covers as assistive technology devices.
- Vocational Rehab: Supports employment-related communication needs.
- TEDP: State telecommunications equipment programs.