Medicare can be used to cover the cost of drug and alcohol rehabilitation. But there are rules about the providers people can use with Medicare, and some types of addiction treatment are not covered by Medicare at all. It is a good idea to contact the Medicare organization directly to find more detailed information.
You may be eligible for Medicare if:1
For individuals with low incomes, Medicaid may be able to supplement Medicare coverage. It can help with coinsurance and mental health services that Medicare does not cover.2
Of course, navigating Medicare can be confusing. The following information covers the basics of using Medicare to access drug treatment.
The short answer is that Medicare can cover drug and alcohol rehabilitation treatment. However, certain conditions must be met for Medicare to provide coverage:3
MedicareInteractive.org offers the following breakdown of services:3
Medicare Part A is generally considered to be hospital insurance. Its main areas of coverage are:4
Part A will cover inpatient care for a substance abuse disorder if the services are determined to be reasonable and necessary.5
Under Part A, an individual can complete no more than 190 days total treatment from a specialty psychiatric hospital. This is the lifetime limit. Care from an inpatient hospital includes care received at:6
An inpatient drug and alcohol rehabilitation program, combined with follow-up care and support, can support a person struggling with addiction to attain long-term recovery. Inpatient program services can include detox, individual therapy, group therapy, addiction education, relapse prevention, 12-step meetings, recreational activities, and aftercare planning.
Part B provides care for outpatient treatment of drug and alcohol rehabilitation.3 As opposed to inpatient care, these programs don’t require residence in the facility during treatment.
Part B also covers partial hospitalization (PHP), which is an outpatient treatment program provided through a hospital or a mental health center.5 A PHP will provide a more intensive program than standard outpatient treatment but still doesn’t require being checked in to a hospital.
A physician must certify that individuals in partial hospitalization require that form of treatment, and the person’s plan of care must include at least 20 hours of treatment per week.5
Services offered in partial hospitalization programs include:5
Part B also covers an alcohol misuse assessment once per year if you’re an adult who drinks but doesn’t meet the criteria for an alcohol use disorder. If through this assessment your provider determines that your level alcohol use is potentially problematic, you may be able to receive up to 4 face-to-face counseling sessions per year.7
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a screening and intervention technique that can help identify individuals at risk of experiencing alcohol related health issues prior to the need for more comprehensive substance abuse treatment. This type of intervention can be covered by Medicare as a preventive measure when someone in a primary care setting shows signs of substance abuse.5
The process includes:5
Medicare D may cover medications used in treating substance use disorders, including drugs for opioid dependence, such as Suboxone. Methadone is not a Part D drug when used for the treatment of opioid dependence because it cannot be distributed at a retail pharmacy. However, it can be prescribed for pain.3,5
Medicare drug programs might not cover all drugs, but they are required to cover antidepressant, anticonvulsant, and antipsychotic medications used during mental health treatment.8
Each specific drug plan under Part D has its own listing of medications that can be covered by the plan—also known as its formulary—so it’s best to make sure that the medications are on the specified formulary of your plan.8
It’s a good idea to contact Medicare directly to get more detailed information and verify the services that can be covered. If you’re a family member or caregiver who is helping to manage treatment for someone covered by Medicare and need their personal information to help with care, have them fill out the Medicare Authorization to Disclose Personal Health Information.
More information and listings of local treatment centers that may accept Medicare can be obtained through the Substance Abuse and Mental Health Services Administration (SAMHSA).
. U.S. Department of Health and Human Services. (2014). Who is eligible for Medicare?
. Center for Medicare Advocacy. Medicare Coverage of Mental Health and Substance Abuse Services.
. Medicare Interactive. Treatment for alcoholism and substance use disorder.
. Medicare.gov. What Part A covers.
. Centers for Medicare & Medicaid Services. (2016). Medicare Coverage of Substance Abuse Services.
. Medicare.gov. Your Medicare Coverage.
. Medicare.gov. Alcohol misuse screenings & counseling.
. Centers for Medicare & Medicaid Services. (2017). Medicare & Your Mental Health Benefits.