Does Medicare Pay For Opioid Abuse and Opioid Addiction Treatment?

Opioid Detox and Rehab Centers that Accept Medicare Near Me

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Does Medicare Insurance Cover Opioid Rehab?

Opioid misuse is a continuing problem for people across the United States. In 2020, approximately 2.7 million people over the age of 12 have an opioid use disorder.1(top) More people overdosed on opioids in 2020 than in the previous 2 years, and the number of infants born exposed to opioids increased too.1(top) People struggling with opioids who have Medicare coverage nationwide can access their insurance to receive some addiction services.

What Does Medicare Insurance Cover for Opioid Treatment?

Medicare healthcare plans cover a variety of mental health and substance use disorder services. Some of these include the following:

  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services: This is an early intervention program. Through screening and intervention, healthcare practitioners can develop strategies to identify drug or alcohol use that is in the early stages before it becomes more problematic. By doing so, the patient can get immediate treatment and a quicker recovery.2(p3)
  • Detox: During detox, individuals will be going through the difficult part of withdrawing from opioids. However, the patient will have a medical professional nearby to assist with the process and ensure that everything goes smoothly.3
  • Inpatient or residential rehab treatment: A patient gets extensive care in an inpatient program. They will stay in a residential setting overnight for 3, 6, or even 12 months. There is a full-time staff on hand to monitor the safe recovery of patients, and therapy is a staple of the program. 4(long)
  • Partial hospitalization program (PHP): A PHP is the next progression down from an inpatient program. It’s structured similarly to a residential rehab, but patients will go to their own homes at night.5 Some of the programs and services in a PHP include therapy, group activities, administered medication (as needed), group therapy, and the services of a full staff.2(p2)
  • Intensive outpatient program (IOP): Outpatient programs have varying levels of intensity, with the IOP being the most intensive. Patients will be able to spend several hours a week at the facility while they continue to work on recovery.6
  • Outpatient rehab treatment: During a standard outpatient program, a patient will be ready for more independence. They will attend weekly therapy sessions where they’ll learn the tools for preventing relapse and successful living.7(outpatient)
  • Behavioral therapies: When a patient goes into Medicare rehab center, they will participate in evidence-based behavioral therapy.8
  • Treatment for co-occurring disorders: Medicare mental health combines with substance use coverage to provide services for a co-occurring disorder diagnosis, if relevant. The patient can receive treatment for both conditions together under one treatment facility.9

What Medicare Insurance Does Not Cover for Opioid Treatment?

Medicare addiction treatment nationwide will cover many of the programs mentioned above. But there may be some services that are not included in the coverage, such as:10(p10&12)

  • Amenities that are not medical in nature.
  • Holistic programs and services.
  • Recreational activities and programs
  • Food delivery services and meal plans.
  • Private or in-home treatment services.
  • Alternative therapies.

What Is Medicare Insurance?

Medicare is a federally funded program for individuals over the age of 65 or with special physical needs.11 Since 1965, when President Lyndon Johnson signed Medicare into law, people have been able to access Medicare benefits.12 Medicare serves approximately 63.8 million members on Part A & Part B.13

How Much Does Opioid Rehab Cost?

Medicare opioid rehab covers a variety of services for substance use. Most of these are covered in Medicare Part B.14 The amount you will have to pay depends on various factors, such as:

  • What services you participate in (inpatient, outpatient, etc.).
  • How long you stay in a Medicare substance abuse treatment facility.
  • The number of amenities or services offered at the facility.

Cost of Inpatient Opioid Rehab

Since Medicare inpatient drug rehab centers nationwide offer the top level of care and service you can receive, you can expect them to have the most cost associated with it.4(long)

Cost of Outpatient Opioid Rehab

The cost of outpatient opioid rehab will vary, too, depending on which form of outpatient treatment you receive. The IOP offers more services and care than standard outpatient treatment.6-7

Cost of Opioid Partial Hospitalization Programs (PHP)

A PHP consists of a higher level of rehab services than outpatient but is a step below inpatient. Therefore, it will be billed accordingly.2(p2)

Cost of Medication-Assisted Treatment (MAT)

MAT rehab uses medication along with therapy and behavioral counseling. Since medication is involved, a physician is required to dispense the medicine. These medications are FDA-approved and are only given at approved facilities, which could be a factor in the cost.15

Opioid Rehab vs. the Cost of Opioid Addiction

As you consider beginning a Medicare addiction treatment program, you may be concerned about the cost you will incur. This is sometimes one of the first things people think about. Although that is a valid issue to look into, you should consider that opioid addiction, on its own, has a cost too. These costs can be summed up as follows:

  • Opioids will cost you money to continue using, especially if you have to buy them from others or “off the streets.” It can become costly as your tolerance level increases, and you need more pills to feel the effects.
  • Many people lose their job or at least lose some hours of work.
  • With continued opioid use, your health may fail, which can cost in medical bills.

What Length of Opioid Rehab Does Medicare Insurance Cover?

When you enter one of the Medicare Insurance rehabilitation centers, you might be wondering how long you will be there and how long Medicare will pay for your stay. Medicare’s length of coverage may come with some variables, such as:16

  • Deductibles.
  • Co-insurance.
  • Co-insurance per each “lifetime reserve day.”

These factors can impact the length of your stay. However, professional clinicians recommend that patients stay in an inpatient program for at least 3 months.17

Choosing Between Medicare Insurance Inpatient vs. Outpatient Opioid Rehab Centers

Starting out with an inpatient Medicare Insurance drug treatment program is ideal over starting with an outpatient program. It makes sense to begin at the highest level of treatment and work your way down to the lowest level.

Also, you gain the following benefits from an inpatient treatment program:

  • You’ll be surrounded by more medical professionals, giving you a greater quality of care.
  • You’ll have a support group near you 24/7.
  • Each day provides a more focused itinerary.
  • You will be held to a high standard of accountability, which can be a strong motivator.

How To Use Medicare Insurance for Opioid Rehab

You can get started on your journey to Medicare drug rehab by following these simple instructions:

  • Consult your doctor if you have one.
  • Find suitable Medicare Insurance drug treatment programs.
  • Determine if your Medicare insurance coverage will pay for the cost of rehab.
  • Call the Medicare helpline.
  • Start the admissions process.

How To Find Opioid Rehabs That Accept Medicare Insurance

American Addiction Centers (AAC) is here to help you begin the journey to sobriety today. Call the helpline, and someone will verify your insurance coverage for you.

AAC has many leading treatment centers across the nation that accept Medicare. When you call AAC, you can talk to an admissions navigator and start the admissions process. They will verify your coverage and check for a Medicare rehab near you.

Will my insurance pay for treatment?
  • We’ll instantly check the coverage offered by your insurance provider.
  • You may receive treatment at one of our facilities at a reduced rate.
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