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Medicare Insurance Covering For Drug & Alcohol Rehab

Medicare Insurance Covering For Drug & Alcohol Rehab


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Disclaimer: We do strive to provide the most accurate and updated information about the addiction treatment insurance coverage of each provider. However, policy changes, as well as errors, do occur. So, confirm with your health insurance provider the level of your coverage.

Medicare Insurance

You have decided to quit alcohol or some other drug. Congratulations! But then you realize you might not be able to afford rehab and treatment. Fortunately, some insurance providers such as Medicare cover drugs, and alcohol rehabs. However, some terms and conditions might disqualify you.

Read on to find out more about Medicare Insurance covering for drugs and alcohol rehabilitation.

Eligibility for addiction treatment under Medicare Insurance coverage

Yes, Medicare does cover addiction treatment for alcohol and other drugs. But to qualify, Medicare requires the meeting of the following conditions:

  • Your healthcare provider should deem the treatment medically necessary
  • You have to receive the treatment at a Medicare-approved facility or provider
  • Your healthcare provider has to set up a plan for treatment

Medicare Insurance breakdown the addiction treatment services as follows:

  • Part A: Inpatient treatment at an approved hospital or rehab center.
  • Part B: Outpatient treatment at an approved outpatient center.
  • SBIRT (Screening, Brief Intervention, and Referral Treatment) services through an approved healthcare provider.
  • Part D: This service pays for medications required to treat substance abuse disorders (SUDs).

Medicare Insurance coverage for inpatient addiction treatment

Part A covers inpatient services. An inpatient program combined with follow-up care and social group support programs is the most effective method of achieving long-term recovery from alcohol and substance abuse. Inpatient addiction treatment programs are comprehensive as they include addiction education, detox, individual and group therapy, relapse prevention, aftercare planning, and 12-step meetings.

The first condition to receive treatment under this service is the determination that the treatment is necessary. Additionally, under Part A, Medicare Insurance has a lifetime limit of 190 days of treatment at a specialty facility. These specialty clinics include:

  • Inpatient rehab centers
  • Long-term care hospitals
  • Mental health care facilities
  • Acute care clinics

Outpatient addiction treatment coverage by Medicare Insurance

Part B provisions provide for outpatient addiction treatment programs.

Also, Part B covers partial hospitalization, aka PHP, where a patient receives treatment during the day and go home at night. For treatment for qualifying as PHP, the care plan should involve at least 20 hours of treatment each week. Addiction treatment PHPs services include:

  • Patient education
  • Therapy – individual, occupational, group, and family
  • Medication
  • Mental health treatments that are medically necessary

Under Part B, Medicare Insurance also covers annual alcohol misuse assessment. This assessment is necessary for individuals whose alcohol abuse does not meet the conditions for an alcohol abuse disorder. After this assessment, if your doctor determines your alcohol abuse has the potential to become an issue, you can qualify for a maximum of four counseling sessions through an approved behavioral therapy provider.

Medicare Insurance coverage for addiction treatment medication

Part D covers the medication used in the treatment of substance use disorders, such as Suboxone. However, part D does not cover Methadone, as you cannot legally buy it a pharmacy.

The medications covered are dependent on the specific drug plan you choose under Part D.

Medicare coverage for SBIRT

SBIRT is an intervention technique, which can help a doctor determine if you are at risk of experiencing substance use disorders. Medicare covers SBIRT when someone who’s receiving primary care shows signs of substance abuse.

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