Who Answers?
Medicare does cover the cost of alcohol and drug rehab, but you must attend an addiction treatment program that accepts Medicare as a form of payment. Medicare doesn’t cover all types of substance abuse services so it’s important to contact Medicare directly to learn more details about your coverage.
In this article:
- Using Medicare to Pay for Addiction Treatment
- What is Medicare?
- Who is Eligible for Medicare?
- Medicare Parts and What Addiction Services They Cover
- How Long Does Medicare Cover Inpatient Rehab?
- Addiction Medications Covered by Medicare
- Alcohol Misuse Screenings
- The Difference Between Medicare and Medicaid
- Can I Receive Coverage Through Both Medicare and Medicaid?
Using Medicare to Pay for Addiction Treatment
Medicare covers substance use disorder screenings, services, and rehab programs. Examples of covered services include:1
- Alcohol misuse screenings
- Opioid use disorder treatment
- Inpatient rehab
- Outpatient addiction treatment
- Partial hospitalization programs (PHPs)
- Telehealth treatment
- Medication-assisted treatment
- Individual and group therapy
What is Medicare?
Medicare is nationwide health insurance offered by the federal government for qualifying individuals. People can opt to receive their coverage in two ways.
Original Medicare
Original Medicare includes hospital insurance (Medicare Part A) and medical insurance (Part B). You pay a deductible at the beginning of each year and then pay 20% of the cost of services (coinsurance). Original Medicare does not cover prescription drugs (Part D).
With this plan, Medicare pays for a portion of covered services, but you’ll be responsible for the rest. If you need help paying your portion, you can sign up for a Medicare Supplement Insurance (Medigap) policy to help pay deductibles, coinsurance, and copayments.2
Medicare Advantage
Medicare Advantage, which is a Medicare-approved plan offered by a private company, is an alternative to Original Medicare for medical and medication coverage. Typically, these plans include Part A, B, and D. You may also receive additional benefits not offered by Original Medicare, such as dental, hearing, and vision services. There are several plans available under Medicare Advantage, with varying out-of-pocket costs and different rules related to accessing healthcare services.2
- Health Maintenance Organization (HMO): HMO plans offered through Medicare Advantage require you to receive in-network care with the exception of out-of-area dialysis, out-of-area urgent care, and emergency care. Some HMO plans offer prescription medication coverage, while others do not.3
- Preferred Provider Organization (PPO): A PPO plan offered by Medicare has a network of hospitals, doctors, and providers. You pay less out-of-pocket fees if you use in-network PPO providers, but you are allowed to use out-of-network providers for covered services as well.4
- Private Fee-For-Services (PFFS) Plans: A PFFS plan offered by Medicare is offered by a private insurance company and determines how much they will pay for services how much you will pay.5
- Special Needs Plans (SNPs): Medicare SNPs are for those who have Medicare Part A and Part B insurance already, live in an area the plan services, and have a chronic condition like alcohol addiction or drug addiction.6
Who is Eligible for Medicare?
The following individuals are eligible for coverage through Medicare:2
- Those 65 years of age or older
- Younger people with disabilities
- Those with End-Stage Renal Disease
Qualifying individuals with limited income can supplement their Medicare coverage with Medicaid, a state and federal program.
Medicare Parts and What Addiction Services They Cover
There are several parts of Medicare that provide different types of coverage, including:2
- Medicare Part A (Hospital Insurance): Covers inpatient hospital stays or inpatient drug rehab
- Medicare Part B (Medical Insurance): Covers outpatient addiction treatment through a hospital or outpatient clinic, as well as alcohol misuse assessments and behavioral health services
- Medicare Part C (Medicare Advantage): Refers to Medicare Advantage plans, which typically include Parts A, B, and D
- Medicare Part D (Prescription Drug Coverage): Covers the cost of prescription medications, such as addiction treatment medications
How Long Does Medicare Cover Inpatient Rehab?
Medicare will cover an inpatient drug and alcohol rehab stay for up to 190 days, which ends up being a little over six months. Keep in mind, the 190 days is a lifetime limit. This coverage includes stays in a variety of facilities, such as:7
- Inpatient rehabs
- Long-term hospitals
- Inpatient psychiatric facilities
- Acute care hospitals
- Critical access hospitals
Inpatient rehab may include a variety of services, depending on your needs, such as medical detox, screening, medication-assisted treatment, individual therapy, group counseling, family therapy, case management, and aftercare planning.
Addiction Medications Covered by Medicare
Medicare Part D and the majority of Medicare Advantage Plans cover addiction treatment medications used in medication-assisted treatment or for medication maintenance.
Opioid addiction and alcohol addiction treatment medications that may be covered by Medicare include:8
- Methadone
- Buprenorphine
- Naloxone
- Naltrexone
- Disulfiram
- Acamprosate
The drugs covered by Medicare depend on your specific plan, so you will need to check the details of your plan.
Alcohol Misuse Screenings
Medicare Part B (medical insurance) covers one alcohol misuse assessment per year if you are 18 or older and use alcohol but don’t meet the criteria for alcohol use disorder. After the screening, if deemed necessary, your provider can refer you to up to 4 brief face-to-face counseling sessions per year.
These screenings can help prevent the development of an alcohol addiction, but if the counselor in the brief therapy sessions determines that you need a higher level of care, you may be referred to a substance abuse treatment program.
The Difference Between Medicare and Medicaid
It can be easy to confuse the two government health insurance programs. Medicare is a federal program providing coverage to people 65 and older, as well as those with disabilities, whereas Medicaid is a state and federal program providing medical coverage for low-income people. Some people may meet the qualifications for both programs.
Can I Receive Coverage Through Both Medicare and Medicaid?
Yes, if you meet the eligibility requirements for both Medicare and Medicaid, you can enroll in both health insurance programs. Those with both types of insurance are referred to as dual-eligible beneficiaries. Medicare may cover approved substance abuse services first and those that aren’t covered are then paid for by Medicaid.
Resources
- Medicare.gov. (n.d.). Mental Health and Substance Use Disorder Services.
- Medicare.gov. (n.d.). What’s Medicare?
- Medicare.gov. (n.d.). Health Maintenance Organization.
- Medicare.gov. (n.d.). Preferred Provider Organization.
- Medicare.gov. (n.d.). Private Fee-for-Service Plans.
- Medicare.gov. (n.d.). How Medicare Special Needs Plans Work.
- Medicare.gov. (n.d.). Your Medicare Coverage.
- Medicare.gov. (n.d.). Opioid use disorder treatment services.
