Does Medicare Cover Alcohol Rehab?

Does Medicare Cover Alcohol Rehab and Substance Abuse?

Troy Frink Medicare, Medicare Advantage Leave a Comment

Substance abuse costs the US more than $740 billion every year. Those costs are related to crime, healthcare, and lost productivity at work.

Overcoming addiction is a lot of work, and it takes a team of mental health and medical professionals to keep you on the right path. You might know that Medicare will pay for doctor visits for illness and injuries, but what you want to know is, “Does Medicare pay for alcohol rehab?”

Medicare does cover many of the costs related to alcohol rehab and treatment if your provider says those services are medically necessary. You must get treatment at a Medicare-approved facility or from a Medicare-approved provider, and that provider must create a care plan.

Addiction Treatment for Seniors and Medicare Eligibles

Outpatient Addiction Counseling | Medicare Plan Finder
Outpatient Addiction Counseling | Medicare Plan Finder

Treatment for addiction is a lot like treatment for any other disease. It starts small, often with preventive measures, and will progress according to the doctor’s recommendations. The American Society of Addiction Medicine (ASAM) divides treatment into five levels of care. Here’s how they relate to Medicare:

Level 0.5, Early Intervention

Education and prevention for people who are at risk of developing an addiction fall under this level. Medicare can cover a conversation with your doctor about a prescription drug that may be habit-forming.

Level 1, Outpatient Treatment

This level of addiction treatment refers to nine hours or less of weekly counseling services or recovery. Outpatient mental health services fall under Medicare Part B and certain Medicare Advantage (MA or Part C) plans.

Level 2, Intensive Outpatient and Partial Hospitalization

These treatment programs are categorized as having more than nine hours of counseling services a week, and/or short inpatient hospital care. Medicare Part A pays for hospital stays of up to 60 days. After 60 days, you will owe coinsurance.

Level 3, Inpatient Treatment

The next level involves up to 90 days in a rehab facility, with a focus on behavioral therapy and staying away from substances. Medicare Part A covers the first 60 days of psychiatric hospital stays. Days 61-90 will cost most people $335/day.

Level 4, Medically-Managed Intensive Inpatient Services

People whose long-term addictions have caused them physical harm need this level of care. It not only involves drug and alcohol counseling but also access to nursing care, prescription drugs, and other medical services. Medicare Part A covers limited home health care, and Medicare Part D and certain Medicare Advantage (Part C) plans cover prescription drugs.

Medicare Coverage and Overdoses

In the event that you or someone you love suffers an overdose, Medicare covers some treatments. For example, most Medicare Part D plans cover Narcan, the drug used to reverse the effects of an opioid overdose. Typical co-pays for most people with Part D and certain Part C plans for Narcan range from $19-$144.

Medicare Part A is hospital insurance, and it will cover your hospital stay, but not all services fall under Part A. Ambulance transportation is under Part B, and so is doctor observation until you are “officially admitted” into the hospital.

Addiction is a disease, and with the right treatment plan, it can be managed. A qualified professional can guide you through the thousands of Medicare plans out there and help you find one that will suit your needs.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Providers

Medicare’s Physician Compare website is a great resource for finding addiction treatment in your area. Click here to get started. You’ll reach a page that allows you to enter your zip code and what type of medical practice you want to find. We chose 37209, which is the zip code for our corporate offices in Nashville, TN. For the practice type, we chose “addiction medicine.” Once you’ve entered that information, click “search.”

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder

That will lead you to a list of local practices that specialize in addiction treatment. You can use the contact information to call the facilities and compare their services, or you can use Medicare.gov’s tool. To use the tool, click on the practices you want to compare. For our purposes, we only chose the top three practices on the list.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder

Then click “Compare” at the bottom of the page.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 3 | Medicare Plan Finder

Then you will come to a page that allows you to view practice contact information on one screen. You can also look at the practices’ full profiles and get directions to each location.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder

Prevalence of Substance Abuse in Older Adults

Older adults (defined as 65 and older in the United States) most commonly abuse alcohol, but many also abuse prescription and illegal drugs. The percentage of older adults who met the criteria for having an addiction problem was 11.7 percent.

Substance Abuse in the Elderly: Unique Issues and Concerns

The elderly population accounts for 25 percent of the prescription drugs sold in the US, and that population faces unique issues when it comes to substance abuse. Because addiction symptoms look like other common senior health disorders such as dementia, diabetes, and depression, addiction often goes ignored.

Help for You or Someone You Love

If you or someone you love struggles with drug or alcohol addiction, you don’t have to face it alone. We can help you find a Medicare plan with the right care team to lead your or your loved one’s recovery. Call a benefits advisor at 833-438-3676 or contact us here today.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

This post was originally published on April 22, 2019, and updated on August 13, 2019.


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