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Medicare

Medicare is a federal health insurance program consisting of four parts that cover different aspects of addiction treatment and rehab.

Does Medicare Cover Rehab?

What Is Medicare?

Medicare is the federal health insurance program for people 65 and older. Certain people under 65 will qualify with a disability or an end-stage renal disease (ESRD) such as permanent kidney failure. Many individuals younger than age 65 qualify for Medicare because of a mental disorder, as defined by the Social Security Administration. Substance use disorders are included in the list of mental disorders covered by Medicare, and Medicare covers a number of addiction treatment services like rehab.

Certain people are eligible for both Medicaid and Medicare coverage, particularly those who are disabled or over 65. A caseworker can help someone determine whether or not they are eligible for benefits from both programs to help pay for individual treatment therapies or substance abuse programs.

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Parts of Medicare

Medicare has four different parts that cover different services.

Medicare Part A

Also known as hospital insurance. Medicare Part A helps cover inpatient care and hospitalization if needed for substance abuse treatment. Medications given during a hospital stay to treat addiction (such as Methadone) are usually covered under this plan. Most individuals do not pay a premium for Part A because they or their spouse have already contributed through payroll deductions from their work years.

Medicare Part B

Also known as supplementary medical insurance. Medicare Part B helps cover doctor’s services, outpatient care, durable medical equipment, and preventive services. It also covers some services not covered under Part A such as physical and occupational therapy. This type of Medicare coverage can also include rehab therapy or prescriptions for medicated assisted treatment.

Medicare beneficiaries with limited income can get their Medicare Part A and Part B premiums, and, in some cases, coinsurance and deductibles paid by Medicaid.

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Medicare Part C

Also known as Medicare Advantage or Medicare Private Health Plan. Part C makes Part A and B benefits and services available through private Medicare-approved health plans for individuals who are eligible for Medicare. These plans must cover the same benefits as Part A and B (Original Medicare) but they are allowed to have different rules for how individuals access services.

Medicare Part D

Also known as Prescription Drug Coverage. Part D is available to those with Parts A and B, or through Part C plans that offer prescription coverage. The premium for Part D is usually paid monthly along with Part B premiums.

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Behavioral Health Services and Rehab Covered by Medicare

Medically necessary services to diagnose and treat behavioral health conditions are covered under Medicare, including most substance use disorders. Coverage under traditional Medicare includes medically necessary services to diagnose and treat behavioral health conditions. People who are covered through Medicare Part C are covered for the same services, but deductibles, coinsurance, and copayments may differ.

Medicare Part A (Hospital Insurance) Rehab Coverage:

Covers inpatient hospital behavioral health care provided in a general or psychiatric hospital. Coverage includes an individual’s room, meals, nursing care, and other related services and supplies. Use of hospital services are measured by benefit periods, which begin the day an individual is admitted to a hospital for physical or mental health care and ends after the individual has not had a hospital or skilled nursing care for 60 days straight. New benefit periods begin after 60 days without hospitalization has passed. When receiving care at a psychiatric hospital there is a lifetime coverage limit of 190 days of inpatient services. Part A also covers alcohol detox and rehabilitation services furnished as inpatient hospital services. Diagnostic and therapeutic services are covered for alcoholism and other substance use disorders.

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Medicare Part B (Medical Insurance) Rehab Coverage:

Part B can help cover outpatient behavioral health services such as visits with a psychiatrist, clinical psychologist or clinical social worker. Outpatient mental health and substance abuse treatment may be provided in a clinic, doctor’s or therapist’s office, or a hospital outpatient department. Other services covered under Medicare Part B are:

  • Psychiatric evaluation
  • Medication management
  • Family counseling
  • Individual and group psychotherapy
  • Occupational therapy as a part of an individual’s mental health treatment
  • Prescription drug that are not self-administered (such as injections)
  • Diagnostic tests
  • Patient training and education
  • Annual depression and alcohol misuse screenings

It  does not cover the following:

  • Meals
  • Transportation to or from health care services
  • Support groups for socializing (unlike group psychotherapy)
  • Testing or training for job-related skills not a part of mental health treatment.

Medicare Part D (Prescription Drug Coverage) Rehab Coverage:

Prescription drugs needed to treat mental or substance use disorders can be covered under Part D. Plans will typically have a list of medications that are covered, called a formulary. Medicare drug plans are required to cover all or almost all antidepressant, anticonvulsant, and antipsychotic medications that may be necessary to keep someone “mentally healthy”. In addition, a state Medicaid program may cover prescription drugs for those who are dual enrolled in both Medicare and Medicaid if Part D does not cover a particular drug.

How to Find a Rehab Program That Accepts Medicare

Medicare can help pay for rehabilitation and addiction treatments such as detox and different therapeutic services. Contact a rehab provider today for help in finding the right program.

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