Does Medicare Cover Alcohol Rehab & Detox? Treatment for Alcoholism

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Does Medicare Insurance Cover Alcohol Rehab?

If you are a Medicare recipient and are in need of substance use disorder treatment, such as alcohol rehab, you may be wondering whether you can use your plan to cover the costs of your care. Medicare is the federal health insurance program for certain individuals across the country.1

Because coverage is extended across the country, there may be a wide variety of alcohol rehab centers that are in-network under your plan. A few different Medicare plans are offered, so it’s important to verify your benefits and coverage before seeking care whenever possible.

What Does Medicare Insurance Cover for Alcohol Treatment?

What Medicare insurance covers for alcohol treatment will depend on your specific plan. There are a few different types of treatments that could be covered and available to you, including the following:

  • Screenings, interventions. Providers may use alcohol screenings or interventions at an initial appointment or consultation to assess your alcohol consumption and behaviors, which can help determine whether you have an alcohol use disorder.2
  • Detox. Depending on your personal situation, you may need to undergo medically supervised detoxification as part of your recovery. Detox, which is the process in which the body is rid of alcohol and other substances, is done in a medically supervised setting to help manage any detrimental side effects.3, para 2
  • Inpatient. With an inpatient alcohol rehab, you would stay at the facility for the duration of your program, which could last for a few days, weeks, or months.4, (How are behavioral therapies used to treat drug addiction?) In these programs, you’d receive round-the-clock medically supervised care.4, (How are behavioral therapies used to treat drug addiction?)
  • Outpatient. With an outpatient alcohol rehab, you would go to your treatment session or sessions each week, but you wouldn’t need to stay overnight. You may need to attend 1 or 2 sessions a week, which may involve group or 1-on-1 therapy sessions.4, (How are behavioral therapies used to treat drug addiction?)
  • Behavioral therapies. Throughout your alcohol treatment, your provider may employ behavioral therapies, which are methods designed to encourage and incentivize you to remain sober, modify your attitudes, and team them with coping skills for managing daily stressors.5
  • Treatment for co-occurring disorders. Someone who has a co-occurring disorder has both a mental illness and substance use disorder (e.g., alcohol addiction) at the same time.6 While it’s not believed that one directly causes the other, it’s believed that having one increases your risk of developing the other. As such, integrated treatment, where each condition is addressed separately but at the same time, is recommended. 6 “What should I do?”

There are a handful of different Medicare health plans. Some of the plans that may be offered include Original Medicare, Medicare Advantage, Medicare Medical Savings Account (MSAs), and Medicare health plans outside of Medicare Advantage and MSAs.1, 7 There are also different parts of traditional Medicare Plans, including Part A, B, and D.1

Eligibility for each plan type is based on specific factors, including your age, and can vary depending on the plan.1 Medicare is also available across the country, but you generally must find a provider who accepts Medicare.8

What Medicare Does Not Cover for Alcohol Treatment?

There may be certain alcohol treatment services that are not covered under your Medicare plan. Some of those services may include the following:

  • Non-medical amenities
  • Holistic care services
  • Recreation programs
  • Food delivery
  • Private treatment services
  • Alternative therapies

Be sure to work with your Medicare representative or call the number on the back of your Medicare plan card to check what is and is not covered.

What Is Medicare Insurance?

Medicare is the federal health insurance program designed for those who are 65 years of age or older, those with end-stage renal disease, or those younger than 65 years old with certain disabilities.1

Medicare was first created on July 30, 1965, after President Lyndon B. Johnson signed into law the bill that led to the creation of Medicaid and Medicare.9 The original Medicare program included Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).9 Today, these 2 parts are called “Original Medicare.”9

Thirty-eight years later, there were new changes introduced to the Medicare program.9 In 2003, the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) was made into law. MMA allowed for the creation of Medicare Part D (which went into effect in 2006), an option prescription drug plan benefit.9 It also allowed private health plans to offer Medicare-approved Medicare Advantage Plans.9

How Much Does Alcohol Rehab Cost?

The overall cost of alcohol rehab will vary based on the alcohol rehab center you choose, amenities offered by the facility, the services offered, the intensity of services, and the duration of your treatment. Choosing an alcohol rehab provider that accepts your Medicare plan could help you keep your alcohol rehab costs down. Be sure to call the number on the back of your insurance card to find out what is covered exactly by your Medicare plan.

If your Medicare plan doesn’t cover your costs of alcohol rehab, there may be payment options available to you. If this is the case for you, you can ask the rehab center whether they offer financing options or have any scholarship opportunities for which you can apply. Be sure to talk to your rehab center to learn more about payment options.

Cost of Inpatient Alcohol Rehab

If you’re attending inpatient alcohol rehab, you may be wondering what your costs may be. If you have Medicare Part A, and your alcohol rehab is deemed to be medically necessary, your Medicare plan may provide coverage for your inpatient alcohol rehab.10 Costs may vary based on whether the facility is an in-network provider and the length of time you’re in treatment.

Cost of Outpatient Alcohol Rehab

If you’re attending outpatient alcohol rehab, your mental health coverage under your Medicare plan may extend to these services. After you meet your Medicare Part B deductible, you may pay a percentage of the overall costs of your treatment.11

Costs can vary based on the type of facility, as hospital outpatient clinics or hospital outpatient departments may require you to pay an additional copay or coinsurance to the facility.11 Be sure to talk to your provider to find out how they work with Medicare for outpatient services.

Cost of Alcohol Partial Hospitalization Programs (PHP)

A partial hospitalization program is a type of alcohol rehab treatment program. Medicare plans may provide some level of coverage for PHP treatment, provided that you meet certain requirements.12

You may have to pay a percentage of the program’s Medicare-approved amount, and after you meet your deductible through Medicare Part B, you will have to pay coinsurance for each day of treatment.12 Finding a rehab center that works with Medicare plans is essential to help keep your healthcare costs low.

Cost of Medication-Assisted Treatment (MAT)

MAT, which is a type of alcohol rehab treatment that uses a combination of medications and therapies to help patients recover from alcohol addiction, varies in cost.13 Depending on the medications being used and whether they’re covered under your Medicare plan, as well as whether you have Medicare Part D, your costs may vary. Call the number on the back of your card to find out what may be covered under your plan.

Alcohol Rehab vs. the Cost of Alcohol Addiction

Although the upfront costs of getting treatment for alcohol addiction may seem steep, it is nothing compared to the long-term costs of continued drinking. Alcohol use disorder can raise the risk that you will become incarcerated—which will cause lost income—or develop a long-term health condition.14

The World Health Organization ties alcohol to more than 200 diseases and other injury-related health conditions.14 “Alcohol and the human body” What’s more, 43.1% of the 85,688 liver disease deaths in 2019 involved alcohol.14 “Alcohol and the human body” These facts go to show that putting off treatment due to the financial costs of care is not as wise as choosing a rehab.

What Length of Alcohol Rehab Does Medicare Cover?

Every person’s path to recovery is different, and the length of time that you may need to be in treatment may be different. Some people do not need to be in treatment for as long as others to overcome addiction. That said, research shows that, generally, longer treatment times are most effective.

Researchers agree that treatments should last at least 90 days to improve positive outcomes and reduce or stop drug use.15 Please work with your provider to determine the right treatment length for your situation. Aside from how long your provider recommends you remain in treatment, your Medicare healthcare coverage may only cover a certain number of days. To find out the length of time Medicare covers for alcohol rehab, call the number on the back of your card.

Choosing Between Medicare Inpatient vs. Outpatient Alcohol Rehab Centers

Determining whether you will attend an inpatient versus outpatient alcohol rehab center is something that should be done with your mental health provider. While one is not inherently better than the other in terms of quality of care, inpatient centers may provide more targeted treatment and support, as the inpatient nature of care may make for a more focused environment.

That is not to say, though, that outpatient treatment cannot provide those same aspects of care. Be sure to talk through these options with your provider to choose what makes the most sense for your and your situation.

How To Use Medicare Insurance for Alcohol Rehab

Using Medicare insurance for alcohol rehab may look a bit different depending on the plan you have. While the general process involves consulting a doctor, finding a suitable rehab program, and determining your ability to use your Medicare insurance at the rehab center, it can be a bit different depending on whether you have Original Medicare, Medicare Advantage, or just Medicare Part D.

You can call the number on the back of your card to speak to a Medicare representative, who can explain your benefits and how to use them. You can also work with the rehab center directly to determine your coverage.

How To Find Alcohol Rehabs That Accept Medicare Insurance?

If you’re searching for an alcohol rehab that accepts your Medicare insurance, we’re here to help. American Addiction Centers provides leading addiction treatment support and services across the country. With leading treatment centers available nationwide, we provide top-notch quality addiction care and work with many different insurers, including Medicare.

Call our helpline today and speak to a real person who can check your benefits right while you’re on the phone. We can go over your insurance information and help you understand what may and may not be covered. We can also help you find a covered facility near you. Don’t wait any longer to get the care you need. Call us today.

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