Medicare Coverage for Drug Rehab & Alcohol Addiction Treatment

Does Medicare Cover Drug Rehab and Alcohol Addiction Treatment?

Medicare Coverage is a government-managed health insurance program that provides comprehensive medical treatment for Medicare beneficiaries. If you have Medicare, it can be used to cover certain types of drug rehab services.1

Does Medicare cover SUD treatment?

Medicare does not have a specific category of benefits for substance use disorder treatment. However, Medicare does provide benefits for substance use treatment, both inpatient and outpatient, that are considered to be necessary.1 ( pg 1-2) 2 Medicare rehab coverage is available for:1 ( p 1-2;) 2(1st section), 3(top)

  • Inpatient treatment in a general hospital or a psychiatric hospital, if necessary.
  • Outpatient treatment, including family, individual, and group therapy, as well as psychiatric evaluations.
  • Intensive outpatient programs to treat your substance use disorder.
  • Partial hospitalization programs (PHPs), which provide a structured intensive alternative to 24/7 hospitalization and meets at least 20 hours per week.
  • Opioid treatment programs, including medication-assisted treatment (MAT).

Medicare Coverage for Substance Use Disorder

Medicare Part A covers inpatient treatment and Medicare Part B covers outpatient services.3 When you receive outpatient treatment, Medicare Part B considers several types of providers as generally eligible to provide necessary and reasonable substance use disorder treatment:1(p 2-3)

  • Physicians
  • Clinical psychologists
  • Nurse practitioners
  • Physician assistants
  • Clinical social workers
  • Clinical nurse specialists

If you need medication to treat substance abuse or mental health disorders, this coverage is provided through Medicare Part D. For example, Suboxone for an opioid use disorder is covered under Medicare Part D for patients who need Suboxone according to their physician.1(p 4)

Within these treatment options for substance use disorders, there are numerous interventions that Medicare will cover, depending on the type of program. In a PHP, for example, Medicare will also cover activity therapy, family therapy, patient education, and occupational therapy.1( p 2)

Medicare does not cover 100% of your costs for treatment. Medicare does have deductibles. For example, for inpatient treatment, a person with Medicare is required to pay a deductible of $1,484 each benefit period and after day 61 of inpatient treatment, a $371 copay for each additional day of treatment.3 For outpatient treatments, you pay 20% of the cost.2 (your costs)

Does Medicare Cover Mental Health Care?

Medicare covers mental health services, both on an inpatient and an outpatient basis. Medicare covers counseling, psychiatric evaluations, hospitalizations, as well as certain injectable medications.1 ( p 1-2),2 (1st section),

For example, for outpatient treatment, under Part B, Medicare will typically cover:2

  • Individual and group therapy.
  • Family therapy, if it helps you manage your mental health condition.
  • Services for medication management.
  • Evaluations from a psychiatrist.
  • Tests related to your mental health.
  • Diagnostic tests.
  • Medication that you can’t give yourself, such as injections.
  • An annual mental health check-up.

Medicare will cover inpatient treatment if medically necessary.3(top) If your doctor wants you to get a treatment that Medicare does not cover, and you agree, you may be responsible for the cost. You may also be responsible for some of the cost if Medicare does not provide coverage for the service as often as your doctor believes that you need it. 3(note section) It is important to know that not every provider who falls under one of these categories is automatically eligible to be reimbursed through Medicare. For Medicare to pay the cost of these services, the provider must accept Medicare assignment. 2 (things to know) In addition, you typically have a 20% co-pay for services, after you have met your deductible.2(your costs)

If you have both a mental health disorder and a substance use disorder, you can benefit the most from getting integrated treatment, in which both types of disorders are addressed at the same time. Having both types of disorders is called co-occurring disorders. Treating co-occurring disorders in one program has been shown to have better outcomes than having each issue treated separately.4(1st paragraph). Many drug rehab programs use cognitive behavioral therapy (CBT), which has been shown to be effective in treating both substance use disorders and mental health disorders.4(behavioral therapies CBT section)

How Long Does Medicare Cover Inpatient Drug Rehab?

Medicare coverage is only available at drug rehab centers that accept Medicare. Medicare rehabilitation coverage is subject to limitations, with coverage provided for treatment as long as it is deemed necessary. Your specific needs in terms of the types of treatment that you participate in, as well as the length of treatment, vary from one person to another. Many factors determine your length and intensity of treatment. Regardless of what types of treatment you participate in, studies have indicated that treatment is most effective when it lasts at least 90 days.5 You can find more information about coverage at Medicare.gov.

What are Medicare Eligibility Requirements?

Medicare provides coverage for adults ages 65 and over. In addition, people who are younger than 65 with certain disabilities or illnesses may be eligible for Medicare coverage. You can determine your eligibility by starting at Medicare.gov.

Does Medicare Pay for Drug and Alcohol Rehab?

Many programs accept Medicare as a form of payment for rehab treatment. The Substance Abuse and Mental Health Services Administration, or SAMHSA, provides a great deal of information about substance use treatment and maintains a treatment locator, which can help you find Medicare-sponsored rehab programs by searching by zip code.

Some people have Medicare Advantage programs, which are slightly different than traditional Medicare. Medicare Advantage programs may have in-network and out-of-network providers. It is best to check with your Medicare Advantage plan to see if a particular treatment program is in-network.7

How to Find a Rehab Program That Accepts Medicare?

While Medicare covers the majority of costs for inpatient or outpatient drug rehab treatment, there are some costs associated with deductibles and co-pays as noted earlier. At American Addiction Centers, our treatment programs accept Medicare, and we can assist you or a loved one with your options and payment for treatment today, giving you the second chance that you need to find hope and recovery from addiction.