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Medicare and Addiction Treatment: What You Need to Know

by Tonya Bales | Feb 16, 2021

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Uncertainty about insurance coverage for addiction treatment services can be a barrier that prevents people from seeking help. Insurers have made significant progress in recognizing the widespread issues surrounding substance use disorder and have begun to provide coverage to meet the need. Medicare has followed suit in making treatment for alcohol and substance use disorder available if certain conditions are met:

  • The service must be deemed medically necessary by your provider.
  • The facility and provider must be Medicare-approved.
  • The provider must set a plan of care for you.

Medicare Insurance Plans

  • Medicare Part A covers inpatient hospitalization care and inpatient care in a rehabilitation facility or hospital.
  • Medicare Part B covers outpatient mental health services, alcohol misuse screenings, and other behavioral health services.
  • Medicare Part C covers anything already included under Medicare Parts A and B, in addition to prescription drug coverage.
  • Medicare Part D covers certain prescription drugs that may be necessary in the treatment of substance use disorder, including suboxone and buprenorphine.
  • Medigap is a Medicare supplement insurance which helps pay out-of-pocket costs under Medicare Parts A and B.

Medicare-covered services include inpatient and outpatient treatment programs for addiction. Both options provide comprehensive care for substance use disorder, but one choice may be better for the patient depending on their needs. Outpatient treatment tends to work best for patients who want to get help for their addiction but need to continue to work or tend to daily obligations while receiving care.

 Medicare Coverage for Outpatient Treatment Programs: Medicare Part B

Medicare Part B covers intensive outpatient treatment for opioid and alcohol use. The services may be provided on site at a medical facility or via telehealth. The services may include:

  • Screenings
  • Individual or group psychotherapy
  • Psychiatric assessment
  • Family counseling that relates to a treatment plan
  • Medication management
  • Diagnostic tests
  • Partial hospitalization

Medicare covers services related to their Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program. This early-intervention approach is intended to help those who may be at risk of developing substance use disorder. The goal is to help a non-dependent substance user from developing a substance use disorder.

Part B Deductible, copayments, and coinsurance apply. Payment plans are available. Learn more about Medicare coverage for opioid use disorder.

RELATED BLOG: Can I afford addiction treatment?

Medicaid Coverage

Some Medicare beneficiaries are also eligible for Medicaid, a state health insurance option that helps cover health care costs for people with lower incomes. If eligible, Medicare beneficiaries may be able to use Medicaid to help cover treatment costs. Read our articles about Medicaid Alcohol Rehab in Greenfield or Medicaid Drug Rehab in Waukesha for more.

RELATED BLOG: “Now I can buy groceries!” What insurance coverage vs. cash for addiction treatment means to patients

Getting Help

If you or a loved one are on Medicare and need help with substance use disorder, contact us today at 833-505-HOPE or through the live chat on our website. We can work with you to create a plan for recovery.

Picture of Tonya Bales

Tonya Bales

Senior Vice President, Revenue Cycle Management

Get Help Now

If you or someone you know suffers from the disease of addiction, please call 833-505-HOPE to speak with a professional.

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