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Does Medicare Cover Drug Rehab?

Female doctor holding aged patient by shoulder soothing her fear. Close up of woman therapist supporting and cheering senior patient in clinic office

Just the Essentials…

  • Substance abuse disorders, like alcohol and drug addiction, are an increasingly prevalent problem among America’s senior population.

  • Symptoms for substance abuse in seniors can commonly be confused with similar symptoms of other physical and mental health issues that are common in individuals who are 65 or older.

  • Medicare can help you or loved one pay for expenses associated with addiction treatment depending on a number of factors.

  • Each part of Medicare can contribute differently to drug and alcohol abuse treatment.

The growing issue of substance abuse among American seniors.

Substance abuse continues to be a growing problem among older Americans, specifically when it comes to alcohol and prescription drug addiction. According to the National Institute on Alcohol Abuse and Alcoholism (NIAA) by way of Addiction Center, this type of substance abuse affects up to 17 percent of adults over the age of 60.

Fortunately, there are resources available that can specifically assist seniors with substance abuse issues. Believe it or not, these resources, treatments, and forms of care are often covered by Medicare. However, before we can discuss how Medicare can potentially offer addiction treatment, we must take a deeper look at how this problem specifically affects older individuals.

How might substance abuse affect senior citizens?

Unfortunately, due to high patient volume and a need for quick turnaround, symptoms of substance abuse in seniors often goes overlooked. Diagnosing a senior with a substance abuse disorder can also be a challenge due to the elderly population’s higher rate of disorders like depression, diabetes, and dementia, which can often mask substance abuse problems.

Some symptoms of substance abuse disorders in seniors include:

  • Memory issues
  • Changes in eating or sleeping habits
  • Unexplained bruises or wounds
  • Irritability, sadness, and depression
  • Unexplained chronic pain
  • A desire for isolation
  • Hygiene concerns
  • Lack of interest in usual activities

Once a potential addiction has been identified, seeking out immediate treatment is necessary. According to the American Society of Addiction Medicine (ASAM) consensus panel, the following treatments are considered effective in substance abuse recovery:

  • Cognitive behavior therapy
  • Group-based therapy
  • Individual counseling
  • Medical/psychiatric approaches
  • Family therapy
  • Case management and community-linked services

Does Medicare cover addiction treatment like drug and alcohol rehab?

You may be pleased to know that the simple answer to the question: “Does Medicare cover drug rehab?” is yes. That said, certain conditions must be met before Medicare will provide coverage for this type of treatment. Those conditions are as follows:

  • One must be eligible for Medicare to receive treatment.
  • Your provider must deem that addiction treatment is medically necessary.
  • Your care must come from a Medicare-approved facility or from a Medicare approved provider.
  • Your provider must set up your plan of care

One typically becomes eligible for Medicare upon attaining the age of 65. In addition, one can become eligible for Medicare coverage upon the diagnosis of certain disabilities or diseases such as end stage renal disease.

The four different parts of Medicare can all contribute to addiction treatment in different ways. Let’s take a closer look at how each part of Medicare works together to provide coverage for addiction treatment.

How do the different parts of Medicare contribute to addiction treatment?

You may already know that Medicare is comprised of four different parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage). However, what you may not know is specifically what the different parts of Medicare cover when it comes to treatment for substance abuse. Let’s take a look at the role of each part in this type of treatment.

Addiction treatment under Medicare Part A

Medicare Part A helps cover the cost of inpatient treatment, such as care received from a hospital or inpatient rehab center. As long as services are deemed reasonable and necessary, Medicare Part A will cover care received from the following inpatient facilities:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehab centers
  • Long-term care hospitals
  • Inpatient care as part of a qualifying research study
  • Mental health care

Many inpatient drug and alcohol rehab centers offer services like detox, individual therapy, group therapy, addiction education, relapse prevention, 12-step meetings, recreational activities, and aftercare planning.

Keep in mind that the lifetime coverage limit a Medicare Part A beneficiary can receive from a specialty psychiatric hospital is 190 days.

Addiction treatment under Medicare Part B

Medicare Part B is designed to assist in paying fore the costs associated with outpatient treatment for drug and alcohol rehabilitation. Programs covered under Part B do not require residence in a treatment facility.

Under Part B, a physician must certify that a Medicare beneficiary requires the treatment they receive, including partial hospitalization programs. Services offered as part of partial hospitalization programs often include the following:

  • Individual and group therapy
  • Occupational therapy
  • Family therapy
  • Patient education
  • Activity therapy
  • Therapeutic drugs that cannot be self-administered
  • Medically necessary diagnostic services for mental health

In addition, Medicare Part B may cover alcohol misuse assessment once per year if you are an adult who does drink but does not meet the criteria for an alcohol use disorder.

Addiction treatment under Medicare Part C

Medicare Part C, also known as Medicare Advantage plans, are insurance plans that are offered by private insurance companies and approved by Medicare. Often, Medicare Advantage plans include the same type of coverage provided by Medicare Parts A, B, and D, plus a few additional options such as:

  • Hospitalization resulting from drug or alcohol overdose
  • Inpatient rehab
  • Outpatient rehab
  • Therapy
  • Psychiatric care, such as psychiatric consultation and prescription coverage for anti-addiction and withdrawal medication

Medicare Advantage plans can vary based on the area in which you live. Contact MedicareInsurance.com by phone at (800) 950-0608 today for assistance researching and comparing plans in your area.

Addiction treatment under Medicare Part D

Medicare Part D: Prescription Drug Coverage can sometimes cover medication used in the treatment of substance abuse disorders, including drugs for opioid dependence.

Each Medicare Part D program provides its own listing of covered medications, and they do not always cover all prescription medication, However, under Medicare regulation, Part D programs are required to provide coverage for:

  • Antidepressants
  • Anticonvulsants
  • Antipsychotic meds used during mental health treatment

Specific anti-addiction medications, like Suboxone or Methadone, may also be included depending on your specific plan.

The importance of getting help for substance abuse issues.

Substance abuse is an issue that can affect people from all backgrounds and of all age groups. For seniors, this issue can be particularly difficult to recognize and treat.

For more detailed information regarding how Medicare can help you or your loved one pay for the costs of addiction treatment, it is typically best to contact Medicare directly. This way, you will receive more detailed information about, and verification of, covered services.

For questions or concerns regarding your Medicare eligibility or to learn more about how you can enroll in or make changes to a Medicare Advantage plan, feel free to contact MedicareInsurance.com via our online chat feature today to speak with a live agent.

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