Medicare is the federal government’s health insurance program for certain people. It provides a wide range of medical healthcare solutions for Americans, including coverage for people dealing with drug or alcohol addiction.1 If you meet the criteria for Medicare coverage (discussed below), you can access the benefits.
If you’re dealing with a substance abuse issue, you probably have questions about your Medicare rehab coverage. It’s important to have an understanding of Medicare drug treatment so that you can begin the recovery process. Delaying addiction treatment will only lead to your condition worsening. So, let’ look a bit closer at how Medicare manages substance addiction issues.
What will Medicare cover?
Medicare offers coverage for an array of medical and mental healthcare issues. It consists of 2 main parts: 2
- Part A: This is the hospital part of the insurance. It covers inpatient hospital care, home health care, nursing facility services, and hospice care. 2
- Part B: This is the medical part of the insurance. It covers most doctors’ services, mental health care, substance addiction care, hospital outpatient services, medical equipment, preventative care, lab tests, x-rays, and some ambulance services. 2
- A drug coverage component of Medicare, Part D, covers certain prescription drugs. 3
With regard to Medicare drug abuse treatment coverage, the following programs and services are covered either in part or whole: 4
- Inpatient rehab treatment (this fall within the Part A section of Medicare)
- Outpatient treatment program (Part B would cover this type of rehab)
- Opioid treatment programs such as medication-assisted therapy and opioid use disorder treatment
- Screening and assessment
- Psychotherapy for substance use disorder
- Other forms of therapy
- Intensive outpatient programs
- Partial hospitalization programs
- Post-hospitalization follow-up
- Patient education about addiction
Does Medicare Cover Mental Health Care?
According to research conducted by the National Institute on Drug Abuse, there is a strong connection between substance abuse and mental health disorders. 5 Approximately 50% of people with a mental illness will struggle with substance use disorder and the reverse holds true. 5 All mental illnesses can lead to an addiction problem, just as any substance addiction could lead to a mental health disorder. However, some mental illnesses stand out when it comes to substance use. These mental health disorders include: 5
- Depression, including bipolar disorder
- Anti-social personality disorder
- Borderline personality disorder
It’s critical to treat mental health disorders and substance abuse issues together so that you don’t cycle back to one problem or the other. You’ll have better long-term recovery success by treating these conditions in tandem.
Medicare provides coverage for some mental health services, such as:6
- Medication management
- Partial hospitalization programs
- Counseling and therapy, including both individual and group therapy
How Long Does Medicare Cover Rehab?
Medicare uses different criteria to determine the length of time it will cover drug rehabilitation. Each person’s needs vary, but there is strong support that indicates a longer stay in rehab will provide better outcomes. The National Institute on Drug Abuse states that patients should be in drug rehab for at least 3 months for treatment to be most effective.7 To find out the length of time Medicare will cover your rehab, you can contact healthcare.gov for more details.
What are Medicare Eligibility Requirements?
Medicare is available for certain categories of people. If you are in the qualifying group, you can enroll in this government-funded health insurance. Those who are eligible for Medicare are either: 8
- 65 years and older.
- Younger than 65 with a qualifying disability.
- Those with end-stage renal disease (sometimes called ESRD), which is permanent kidney failure.
Medicare Sponsored Rehab
When you look for drug rehab centers that accept Medicare, you can call the rehab facility directly and ask them if they accept it or call the number on the back of your Medicare card. For a faster response, you can verify your insurance online and get an instant answer.
Keep in mind that rehab centers that accept Medicare have been approved by the government. They must abide by certain requirements, including certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and enrollment in the Medicare program.4
Once you find a Medicare-covered rehab treatment provider near you, then you can be assured that they will be certified with SAMHSA.
If you’re concerned about Medicare not covering the entire cost of drug addiction treatment, American Addiction Centers (AAC) is here to assist you with finding a way to get the help you need. They can speak to your family or friends about financing the treatment, offer a potential financing plan, or arrange payments on a sliding-scale fee. You deserve to have a second chance at life. With a helping hand, you can move forward and begin the healing process.
American Addiction Centers employs certified, high-quality therapists and staff who are equipped to deal with all types of substance abuse. They offer an array of treatment plans to suit you wherever you are on your journey. Some of these treatment plans include:
- Inpatient residential treatment
- Partial hospitalization treatment
- Intensive outpatient treatment
- Outpatient treatment
- Co-occurring disorder treatment
- Telehealth addiction treatment
- Medical detox
Through participation in evidence-based therapies with Master’s-level therapists, you will be well on your way to a new future. Some therapies offered at an AAC rehab include:
- Cognitive-behavioral therapy
- Dialectical behavioral therapy
- Family therapy
- Yoga therapy
- Music therapy
- Animal-assisted therapy
Contact American Addiction Centers to speak to an intake coordinator about the admission process. Someone can verify your insurance and get you started with an evaluation. Call the 24/7 hotline at 1-888-287-0471 .
- Medicare Interactive. (2021). What happens when not all doctors accept Medicare—do you have to switch?
- The Official U.S. Government Site for Medicare. What Medicare covers.
- The Official U.S. Government Site for Medicare. Drug coverage (Part D).
- Medicare Interactive. Treatment for alcoholism and substance use disorder.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders research report
- Centers For Medicare & Medicaid Services. (2020). Medicare & your mental health benefits.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide.
- The Official U.S. Government Site for Medicare. What’s Medicare?