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Medicare Insurance Coverage for Drug and Alcohol Rehab

Medicare is a federal health insurance program that helps people over the age of 65 afford quality healthcare. Depending on your plan and qualifications, it can make addiction treatment more accessible for those who need it. For more information about your addiction treatment options, call .
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Medicare Insurance Coverage for Drug and Alcohol Rehab

Does Medicare cover drug and alcohol addiction treatment? Yes, when you need drug or alcohol addiction treatment, Medicare healthcare coverage can help with costs and cover at least some parts of your care. This article will help you find out about eligibility and how Medicare can help make the cost of rehab more affordable.

What Is Medicare?

 

Medicare has 3 parts that cover different services for people aged 65 and older and people under 65 who have a disability and meet certain income-based requirements.1 Medicare also works with the Federal Employee Health Benefits (FEHB) program and Veterans Affairs to provide additional coverage to federal employees and veterans.

Medicare is state and federally funded to provide people with the financial resources they need for healthcare, including addiction treatment. The program provides health insurance to people who meet specific age, disability, and income requirements.

Medicare has 3 main parts—A, B, and D—that cover health services including both inpatient and outpatient drug rehab as well as partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs). To qualify for Medicare, you must be a U.S. citizen or have been a permanent legal resident for at least 5 years.1

Does Medicare Cover Drug and Alcohol Addiction Treatment?

Medicare generally covers drug and alcohol rehab, but it may not cover all aspects of addiction treatment. Original Medicare Part A covers inpatient care for up to 190 days.2 The cost depends on your plan. You typically pay your deductible for the first 60 days and then cover a portion of the cost if you stay longer.

Costs may vary for outpatient care, depending on the type of treatment you need. Medicare mental health coverage is also included as required by the Affordable Care Act (ACA). It covers therapy for co-occurring disorders like anxiety, depression, and other mental health disorders.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

Check if Medicare Covers Drug and Alcohol Rehab

Before choosing a drug and alcohol addiction treatment center, check your Medicare policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your insurance card or log in to your account on Medicare’s website to learn more about what your specific policy plan covers.

Knowing exactly what your Medicare plan covers can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Medicare insurance plans and to check what your plan covers, call , click here, or fill out the form below.

What Types of Drug and Alcohol Rehab Does Medicare Cover?

With most Medicare plans covering at least some of the costs of rehab for alcohol addiction or drug addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:3

  • Detox services: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, or even life threatening. Medical detox helps you safely withdraw from drugs and alcohol, as you’ll receive around-the-clock supervision. You may also be given medications to help minimize withdrawal symptoms.
  • Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs.
  • Partial hospitalization (PHP): Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.
  • Intensive outpatient program (IOP): Intensive outpatient programs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and go to work during the day.
  • Outpatient treatment: Individuals who have completed inpatient treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

When you decide to get treatment for drug or alcohol addiction, you will need to decide with your healthcare provider or addiction specialist what type of treatment is best for you.

Do Rehab Centers Need to Be In-Network to Accept Medicare?

In most cases, you will need to seek treatment at a facility that is in-network with Medicare to receive your full benefits. Even if you choose a treatment facility that is in-network, you may still be responsible for some of the treatment costs.

If you choose a facility that is out-of-network, you may be responsible for all the costs of your addiction treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the facility.

What Are Medicare’s Coverage Levels and Plans?

Medicare has 3 components that cover different areas of care:1

  • Part A: Covers hospital insurance, including inpatient care associated with addiction treatment.
  • Part B: Applies to outpatient care, including doctor visits, preventive care, and outpatient addiction treatment.
  • Part D: Covers prescription drug costs, including medications for addiction treatment.

There are 2 types of Medicare coverage:1

  • Original Medicare: This plan includes Medicare parts A and B. It covers partial costs for care, including addiction treatment. You can also add Part D for more coverage.
  • Medicare Advantage: This plan includes parts A, B, and D in one package and allows you to combine your Medicare coverage with other Medicare-approved insurance plans.

Does Medicare Cover Alcohol Rehab?

Yes, under the Affordable Care Act, insurance companies are required to cover some, if not all, of the cost of addiction treatment.4 So, your Medicare insurance should provide at least some coverage for your alcohol rehab and addiction treatment services.

How to Verify the Coverage of Your Medicare Plan

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and specific services received. When you sign up, Medicare will send you information about your health coverage along with a directory of rehab centers that work with Medicare. You can also search the Medicare website to find out if your service is covered, or contact Medicare representatives by calling the number on your Medicare ID card.5

To find state-specific coverage, visit your state’s official website. Log in and verify your coverage to find your details. You can also call American Addiction Centers and speak with one of our admissions navigators at . They can provide you with information about treatment coverage and answer any questions you have.

What Should I Do if Medicare Won't Cover the Total Cost of Rehab?

Individuals with Medicare who need addiction treatment must go to a Medicare-approved facility to receive coverage. If Medicare doesn’t cover the full cost, and you have trouble affording care, there are other ways to afford treatment.

Some ways to pay for rehab include:

  • Payment plans: You pay for rehab in affordable installments.
  • Sliding scale: The rehab decreases your cost to something you can reasonably afford—typically based on your income level.
  • Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehabs, offer grants and scholarships to pay for people who can’t afford treatment.
  • Purchase affordable insurance on the Healthcare Marketplace.
  • Open a healthcare credit card or take out a specialized healthcare loan.
  • Use your savings or a credit card.

Here are additional resources that provide more information about other ways to pay for rehab with or beyond what Medicare covers:

Medicare may not cover everything, but it can make treatment more affordable. Your coverage depends on your plan and what kind of treatment you need. Take the first step toward getting help: go online or call AAC at to speak with an admissions navigator today.

Sources

  1. Medicare.gov. (n.d.). What’s Medicare?
  2. Medicare.gov. (n.d.). Inpatient Rehabilitation Care.
  3. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide. (3rd ed).
  4. Healthcare.gov. (n.d.). What Marketplace health insurance plans cover.
  5. Medicare.gov. (n.d.). Welcome to Medicare.
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