What is Medicaid?
Medicaid is the largest healthcare insurance program in the country.5 It is a joint federal and state program that provides free or low-cost insurance coverage to low-income applicants who are:6
- 65 or older.
- 19 or younger.
- Caring for a child.
Under the Affordable Care Act, eligibility for Medicaid coverage has expanded to include other groups and income levels, depending on your state.
If you applied for Medicaid coverage prior to 2010 or in a different state and were turned down, consider re-applying based on the expanded coverage now available.
Question: Does Medicaid cover substance abuse treatment?
Answer: Yes. Every state is different, but they all cover behavioral health services for people with substance use disorders. To find out what your state covers, you can call your State Medical Assistance (Medicaid) office or visit Medicaid.gov.
Not all rehab facilities accept Medicaid. To find a treatment center that takes Medicaid, check out SAMHSA’s Behavioral Health Treatment Services Locator tool.
How to Enroll:
Apply online for Medicaid by visiting Healthcare.gov or Medicaid.gov and filling out the application. To see if you qualify for Medicaid based on income alone, visit this page.
There is no limited enrollment period for Medicaid. If you qualify, your coverage will be effective either on the date of application or the first day of the month of you applied.
What is Medicare?
Medicare is a federal insurance program that provides coverage for people who are:
- 65 or older.
- Of any age and living with certain disabilities.
- Of any age and living with end-stage renal disease (ESRD) or ALS (Lou Gehrig’s disease).
Medicare benefits include 4 parts:
- Part A is hospital coverage.
- Part B is general medical coverage.
- Part C is also known as Medicare Advantage and is a different path to receiving the coverage provided in parts A and B.
- Part D is prescription drug coverage.
For more information and a comprehensive overview of Medicare, check out this video
We are here for you in your journey to recovery. Learning about insurance is intimidating and scary to most people. Don’t worry, there are many resources available to make it as easy as possible.
How to Enroll
If you think you qualify for Medicare, apply online at Medicare.gov. The process is easy and can be done from the comfort of your own home. Check out this easy-to-read guide on how to sign up for Medicare in less than 10 minutes.
The Medicare program has enrollment periods for new applicants. People usually sign up during the initial enrollment period, which is around their 65th birthday. Below is a list of open enrollment dates:
- Medicare Initial Enrollment Period (IEP): The IEP begins 3 months before your 65th birthday and lasts until 3 months after you turn 65. If you have been receiving Social Security benefits for more than 2 years, you will automatically be enrolled in Medicare.
- General Enrollment Period (GEP): If you missed the IEP, you can enroll in the GEP Jan. 1–March 31 every year. If you enroll during this time, your Medicare coverage begins July 1.
- Medicare Special Enrollment Period (SEP): Qualifying life events (QLEs) allow you to enroll in Medicare or change your plan outside of the annual GEP. Examples of QLEs include, but are not limited to:7
- Losing your current coverage.
- Adding or dropping other coverage.
- Changing your Medicare plan.
- Medicare Open Enrollment: Once you choose a plan you do not have to stay with it forever; you can make changes to your Medicare coverage as your health changes. Open enrollment occurs every year from Oct. 15–Dec. 7, and you can change plans during this time.
- Medicare Supplement Open Enrollment: At any time during the year, you can add supplemental insurance to your plan if you are enrolled in Medicare Part A and Part B. Supplemental insurance can help you pay for costs that Parts A and B don’t cover.
So, what’s the difference between Medicare and Medicaid, and the health insurance marketplaces (or “exchanges”) established under the Affordable Care Act? Check out this comparison graph:
|Who oversees the program?
- Age 65 or older
- Any age, with certain disabilities, ESRD, or ALS
- A defined bracket of low-income people, families and children, the elderly, people with disabilities, and pregnant women.
- In some states, coverage applies to all individuals who fall below a certain income level.
|Does this insurance cover substance abuse treatment?
||Yes, if the following criteria are met:
- The facility is a Medicare-participating provider,
- Treatment is medically necessary, and
- Your doctor creates a plan for your treatment.
|How do I enroll?
- Inpatient care
- Outpatient care
- Post-hospitalization follow-up
- Outpatient prescription drugs
- Screening, brief intervention, and referral to treatment (SBIRT)
- Varies by state.
- Most states cover inpatient detox, partial hospitalization, intensive outpatient, and case management.
- Inpatient treatment
- Outpatient treatment
|Who oversees the program?
|When can I enroll?
||During the 7-month period around your 65th birthday. Most people who turn 65 are automatically enrolled in Parts A and B.
||Any time of the year.
||During open enrollment periods each year. View dates and deadlines here.
|Are there special enrollment periods?
||Yes. Click here for more information.
||Yes. Click here to find your state’s Medicaid department.
||Yes. Visit this website for more information.
Utilizing the Affordable Care Act
The Affordable Care Act (ACA, frequently referred to as “ObamaCare”) was signed into law in 2010.
It expanded Medicaid coverage and established affordable health insurance marketplaces for people who don’t have other means of obtaining insurance, such as private insurance through their employer, or public insurance through Medicare or Medicaid.
The ACA was a major victory for people struggling with addiction because it requires all insurance policies sold via the marketplace to cover substance abuse and mental health treatment. For more information about the specific coverage required, visit this website.
The expansion of Medicaid under the Affordable Care Act extended coverage for substance abuse treatment to 1.29 million low-income Americans who struggle with addiction.13
Anyone can purchase an insurance policy through the health insurance marketplace. Every state has its own marketplace; find yours by visiting this website.
How to enroll?
Apply for health insurance through your state’s exchange by visiting Healthcare.gov. The application process takes roughly 15 minutes. Once approved, enroll in a plan that meets your treatment needs and financial situation.
If you enroll before the 15th of the month, your coverage will start on the 1st of the next month. Get started on your application today.
There are yearly open enrollment periods to apply for coverage through the insurance marketplace. If you miss open enrollment, you may be able to qualify for special enrollment. Qualifying life events include:
- Losing insurance coverage.
- Getting married, divorced, or having a baby.
- Leaving jail.
For a full list of events that qualify you for special enrollment, click here.
What are the Benefits of State-Funded Programs?
State-funded rehab programs are facilities that receive government grants or subsidies to run treatment programs, often in connection with jails or the court system for providing court-ordered addiction treatment. Because of limited funding, these facilities typically do not provide the same amenities (private rooms, lower staff-to-client ratios, innovative treatment approaches) as you’ll find in private centers. Try not to write these off—if you need treatment and have very limited resources, state-funded facilities are an option you should consider.
Not everybody is able to go to a private facility. If this is your only option, take advantage of it! Your life is valuable and you deserve professional treatment.
Don’t be discouraged if you call to enroll in a state-run facility, only to find that they are full. Many people seek treatment here because they can’t afford private treatment. Most state-funded facilities can put you on a waitlist if they are full. Although this is not ideal when you are geared up and ready to enroll in treatment, it’s better than nothing. Plus, you never know how quickly a bed can open up. As long as you’re on the waitlist, there is hope that you will get into treatment soon.
To find state-funded treatment centers in your state, check out SAMHSA’s Directory of Single State Agencies (SSAs) for Substance Abuse Services.
Just because you’re on a waitlist for formal treatment doesn’t mean you can’t seek out 12-step programs or other recovery groups in your community. Here you’ll find connections and support. In fact, you may find people who work at treatment facilities in the area, or who know of other places that can help you. Staying engaged with other people in recovery will help keep you stable until you get admitted into treatment.
Find Strength in Support Groups
Participation in a 12-step or non-12-step group is frequently recommended as a complement to addiction treatment programs, but anyone is welcome to join these free group sessions. Even if finances or insurance keep you from enrolling in formal treatment right away, you can still benefit from the supportive community these groups offer.
If you’re nervous about joining a group of new people to talk about your personal experiences with addiction, that’s completely normal.
Just remember that the benefits of 12-step programs are widely recognized by treatment professionals. Listening to people who have been sober for a long time can inspire you to change your own behaviors and stop using them.
12-step support groups help members work the 12 steps originally developed by Alcoholics Anonymous. The steps have since been applied to substance and behavioral addictions of all types, as well as the family members of those suffering from such addictions.
12-step groups include:
If you do not feel comfortable with the spiritual tenets or any other aspects of 12-step groups, there are alternative recovery support groups that you may find more appealing. These meetings are non-religious, but provide similar outlets for support as 12-step meetings.
Non-12-step groups include:
Call a Helpline for Information
These helplines provide free and confidential support services—no insurance required.
If you are looking for more information on how to move forward with treatment, or just want to talk to someone who knows what you’re going through, these helplines can be a great place to start.
- The Substance Abuse and Mental Health Services Administration (SAMSHA) operates a National Helpline at 1-800-662-HELP (4357). The helpline is open 24 hours a day and offers assistance in English and Spanish. In addition, SAMHSA’s behavioral health treatment services locator provides an online search of substance abuse and mental health treatment programs in the U.S.
- The Alcohol and Drug Helpline can help you find a treatment center regardless of insurance coverage, income level, or age. Reach them 24 hours a day by calling 1-206-722-3700.
- Boys Town National Hotline is a resource for teens, families, and parents. Representatives are trained counselors and are available 24 hours a day at 1-800-448-3000. Counselors can offer assistance in English and Spanish and may help refer you to a treatment center.
- The National Suicide Prevention Lifeline is an excellent resource for free, confidential support and resources. Reach them 24 hours a day at 1-800-273-8255.
- The National Runaway Safe Line provides support in crisis counseling. The Safe Line can be reached at 1-800-RUNAWAY.
The Americans with Disabilities Act (ADA): Are you worried about losing your job for seeking help for substance abuse treatment? According to non-discrimination laws, people who are battling an addiction are considered to have a disability and are protected under the Americans with Disabilities Act (ADA). The ADA and the Rehabilitation Act protect employees from getting fired for seeking treatment.14
The Police Assisted Addiction and Recovery Initiative (PAARI): This nonprofit organization helps people find rehab treatment. If you struggle with drug or alcohol abuse, and you ask a participating police department for help, they will take you to the hospital and/or treatment program instead of arresting you. Participating departments are listed on this page and can help you get adequate treatment.
Supplemental Security Income (SSI): In most cases, if you are receiving SSI, you are automatically eligible for Medicaid coverage. When you apply for SSI you also apply for Medicaid.15 For more information on SSI and Medicaid coverage, visit this website.