Medicare Drug And Alcohol Rehab Coverage

Certain forms of Medicare coverage may be used to obtain treatment for a drug or alcohol addiction, including services for outpatient or inpatient treatment.

Drug And Alcohol Rehabs That Accept Medicare Health Insurance

If you’re seeking treatment for a drug or alcohol addiction, it’s in your best interest to examine your Medicare benefits before pursuing treatment. Doing so can help to alleviate some of the financial stress involved with obtaining treatment. It may also give you more flexible options for treatment.

Understanding Your Medicare Benefits

According to Medicare.gov, there are two ways to receive coverage, either through Original Medicare or a Medicare Advantage Plan (Part C). Medicare has two forms of coverage, Part A and Part B, each of which provide different health care benefits, and both of which may provide some measure of assistance for the treatment of a substance use disorder (SUD).

Medicare health plans are typically provided by private companies who contract with Medicare to offer individuals Part A and Part B benefits. Individuals receiving benefits through Parts A or B may be eligible for Part D, Medicare’s prescription drug coverage.

In order to obtain coverage for substance abuse treatment, you will likely have to show that the required services are medically necessary. To do this, you may have to provide Medicare with documentation of the addiction and need for treatment. This may include medical records and letters from your medical team.

Outpatient and inpatient treatment may only be provided if the rehabilitation facility is Medicare-certified as established by Department of Health and Human Services (HHS) guidelines.

Medicare also covers Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services. These services provide an early intervention for individuals at risk of developing a substance use disorder. This screening also evaluates the severity of abuse, so that individuals who are addicted can be referred to the appropriate treatment program.

Does Medicare Cover The Cost of Outpatient Substance Abuse Treatment?

Outpatient mental health services are covered through Medicare Part B. This may include treatment for a drug or alcohol addiction.

Covered services may include a depression screening, psychiatric evaluation, medication management, family counseling, and individual and group psychotherapy.

Treatments may be delivered by a variety of medical professionals through this coverage, including:

  • psychiatrist or other doctor
  • clinical psychologist
  • clinical social worker
  • clinical nurse specialist
  • nurse practitioner
  • physician assistant

A partial hospitalization program (PHP) may also be covered through Medicare Part B. A PHP is an intensive outpatient psychiatric day treatment program which provides an alternative to inpatient treatment. These services must be provided through either a hospital outpatient department or community mental health center.

As part of your Part B benefits, your care should be evaluated to determine if you’re receiving the care you need and to see if the treatments are beneficial to your recovery.

Through Original Medicare a person may pay 20 percent of the Medicare-approved amount in order to obtain a diagnosis or treatment for their SUD. Your Part B deductible will apply. If outpatient services are provided by a hospital, you may be responsible for an additional copay or coinsurance.

Does Medicare Cover The Cost Inpatient Drug And Alcohol Rehab?

Medicare Part A may provide inpatient treatment for mental health care services, including substance use disorders. Inpatient treatment may be made available in a hospital setting or at an inpatient rehabilitation facility.

If you have Original Medicare, you will have a set deductible each benefit period. You will also have a coinsurance that is dependent on the specific day of the benefit period.

Even if you still have to pay a portion of the out-of-pocket costs, you shouldn’t reject the idea of inpatient treatment. Though these services are generally more expensive than outpatient programs, residential programs quite often provide more long-lasting and successful results.

This is because treatment participants have more time to develop the coping, relapse prevention, and stress reduction skills which protect their recovery. This occurs through more in-depth interactions with therapists, counselors, and peer support groups during treatment.

Should you still require additional forms of payment assistance, consider the possibility of scholarships and grants, loans, and financing, among others. Each of these can help to round out the amount you’re responsible for paying.

Does Medicare Cover the Cost of Suboxone?

Suboxone is a medication used during medication-assisted treatment (MAT) for the treatment of an opioid use disorder. It is a combination of buprenorphine and naloxone which helps a person to reduce or quit the opioid drug of abuse, such as heroin or prescription opioid painkillers like oxycodone (OxyContin).

Buprenorphine may be covered by a Medicare drug plan if it’s considered medically necessary and if it’s on the plan’s formulary. If it’s not on the formulary an exception may possibly be made. In order for buprenorphine-based drugs to be covered they must be dispensed by a Medicare-certified program or facility for use during inpatient or detoxification services.

Does Medicare Cover the Cost of Methadone Maintenance?

Methadone is also used within MAT to treat opioid use disorders. But unlike buprenorphine, a person can only receive methadone directly from an opioid treatment program.

Methadone is not considered a Part D drug for opioid dependence due to the fact it cannot be obtained through a prescription at a retail pharmacy. Public healthcare policy is always changing, however, so this does not mean that methadone will not be covered at some time in the future.

If you’d like more information on a program which offers methadone maintenance, we can help you to examine your treatment options.

Finding A Rehab Center That Accepts Medicare

As you look at your options for treatment, make sure to look at the unique circumstances within your life. For instance, if you have any health or medical concerns which accompany the addiction, find out if there’s a facility which accepts Medicare that can treat these too.

One of the biggest concerns here are co-occurring mental health disorders. Mental health disorders like anxiety and depression quite commonly lead to or result from substance abuse. In order to fully treat both conditions, treatment should simultaneously address both needs. This is referred to as dual diagnosis care.

If you require a medically-supervised detoxification you’ll also want to select a program which offers this service adjacent to their rehabilitation. This service is particularly important to consider if you’re facing an addiction to alcohol, benzodiazepines, or opioids.

Contact OpioidTreatment.net today to learn more about your treatment options under your Medicare coverage.


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