Does Medicare Cover Drug Rehab?
If you’re struggling with an addiction to drugs or alcohol, rehab can be the cornerstone for your recovery. But if you’re 65 or older, or receiving Social Security Disability Insurance (SSDI), though, Medicare may cover many, if not all, the costs of receiving help for addictions of all kinds.
How Can Medicare Help?
Medicare is a federally funded healthcare support program for seniors and people with ongoing disabilities. Medicare Part A covers most costs of hospitalization, while Part B covers general medical services such as doctor visits and outpatient procedures. Many people also enroll in Part D, which helps with the costs of prescription medications. Medicare covers either all or a part of the costs of covered services, and users pay a co-pay for the difference.
Medicare will cover most if not all the costs for drug and alcohol rehab services if:
- Services are provided by a Medicare participating provider or facility such as a hospital or clinic
- A participating doctor establishes that rehab services are medically necessary
- The doctor sets up a plan of treatment
Medicare Coverage for Inpatient Rehab
Medicare Part A (hospitalization) provides its standard coverage for a hospital stay for anyone who is hospitalized for substance abuse treatment. Hospital stays for drug treatment can include support for detox and withdrawal, counseling and medications.
Medicare makes one important exception to this policy, and this can affect people with a dual diagnosis – a mental health condition along with addiction. The program will cover only 190 days in a dedicated psychiatric hospital over a user’s entire lifetime. If a patient reaches that limit, Medicare may cover more mental health treatment, but only if it’s provided in a general hospital or in a clinic associated with a hospital.
Medicare may also pay all or part of the costs of partial hospitalization programs, or PHPs. This kind of program combines features of both inpatient and outpatient rehab, so that users spend their days in intensive addiction therapy, but they spend evenings and weekends at home.
Medicare Also Covers Outpatient Rehabs
Medicare’s Part B (medical) coverage can help with the costs of outpatient rehab services when those services are provided through a hospital’s outpatient medical programs or a clinic that provides medical services. Typically, Medicare pays for 80 percent of the approved amount for mental health and drug rehab services provided on an outpatient basis. The remaining 20 percent can be paid out of pocket or by supplemental insurance plans.
Outpatient rehab services that are typically covered by Medicare Part B include:
- Post-hospitalization follow-ups
- Patient education on diagnosis and treatment
- Prescription drugs administered during hospitalization or at a doctor’s office
Medicare Can Cover Medications Too
A number of medications can help with treating addiction, and Medicare’s Part D for prescription medications can also help with the cost of these drugs if they’re dispensed at a pharmacy on prescriptions from a Medicare approved physician.
One exception to this policy involves methadone, a medication commonly used to help people recover from an addiction to opioid drugs such as heroin or prescription pain medications. Medicare will not cover methadone for drug abuse treatment, since it can’t be dispensed by a pharmacy for this purpose. Medicare will only pay for methadone if prescribed for pain.
SBIRT – Another Medicare Benefit
Medicare also provides coverage for a service called Screening, Brief Intervention, and Referral to Treatment, or SBIRT. This service is provided by outpatient clinics and physicians when a patient shows signs of being at risk for substance abuse or addiction. SBIRT includes:
- Assessing the problem
- Briefly educating the patient about the potential problem and its consequences
- Referring the patient to appropriate services to prevent the problem
Drug and alcohol abuse is a hidden but growing problem among those over 65. With services for both inpatient and outpatient drug abuse treatment, Medicare can help to cover the costs of recovery in every state.
Are you searching for help to stop using drugs or alcohol – but worried about the costs? We’re here to help you find the answers you’re looking for. Contact us at 800-430-1407Who Answers? for the solutions you need right now.