For those who have Medicare and struggling with an addiction to drugs or alcohol, you will be happy to know that Medicare can help cover some of the costs associated with addiction recovery. For those who are not as familiar with Medicare, it is a federal health insurance program originally designed to help those who are age 65 and over receive the medical treatments that they need. Now, this same coverage, which is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services, can help many older adults struggling with addiction turn their lives around.
HOW TO QUALIFY FOR MEDICARE
Whether you need Medicare to help cover the cost of substance abuse or standard medical treatments, you will first need to qualify for benefits. And to be eligible, you will need to meet at least one of the following:
- Age 65 or over
- Have a disability
- Under the age of 65 and diagnosed with end-stage renal disease
WHAT YOU SHOULD KNOW ABOUT SUBSTANCE ABUSE TREATMENTS COVERED BY MEDICARE
If you meet any of the eligibility requirements detailed in this article, you will more than likely qualify for Medicare coverage, which can be used to cover the cost of addiction recovery. However, substance abuse treatments covered by the federal health insurance program can vary depending on the type of Medicare plan that you have in place. For those who are not familiar with how Medicare works as it relates to substance abuse coverage, the federal health insurance program consists of parts A, B, and D, each covering specific aspects of the addiction recovery process. And the complexities do not end there as those seeking Medicare-covered substance abuse treatments will also have to meet the following requirements:
- You must have a letter of medical necessity from a licensed physician confirming substance abuse treatments are medically necessary.
- You will need to work with your physician to outline a treatment plan.
- You must receive substance abuse treatments for an approved Medicare facility.
WHAT SUBSTANCE ABUSE TREATMENTS WILL MEDICARE COVER?
The substance abuse treatments covered by Medicare are determined based on whether an individual has a Medicare part A, B, or D plan.
Part A – This aspect of Medicare will help cover the cost of inpatient treatments that require hospitalization or standard inpatient treatments at an approved rehab facility.
Part B – This aspect of Medicare will help cover the cost of outpatient treatments received at either a clinic or hospital. That said, those who receive hospital-based outpatient treatments, commonly referred to as partial hospitalization (PHP) treatments, are also eligible to have the following substance abuse treatments covered under Medicare part B:
- Substance abuse counseling
- Addiction education courses
- Diagnostic testing to address mental health concerns
Part D – This aspect of Medicare will help cover the costs associated with medication-assisted detox, which is needed to help individuals overcome serious substance abuse problems, such as an alcohol use disorder or an addiction to opioids, for example.
MEDICARE PART D AND MEDICATION-ASSISTED ADDICTION RECOVERY TREATMENTS
When it comes to the drug plan associated with Medicare part D, there are several limitations worth noting. For example, Suboxone, a medication used to ease severe opioid withdrawal symptoms, is covered under Medicare part D while Methodone, which is just as effective, is not. Additionally, Medicare part D will only cover the cost of antidepressants, antipsychotics, and anticonvulsants if the medications are being used to treat a co-occurring disorder or stand-alone mental illness brought on by substance abuse. There may also be other restrictions and limitations as well. Therefore, you should contact Medicare directly to learn more about coverage for prescription-based medications under Medicare part D.
COMBINING MEDICARE AND MEDICAID BENEFITS
Similar to other health insurance providers, Medicare may not cover all substance abuse treatments at 100 percent, meaning some individuals will be responsible for paying certain copays and other out-of-pocket expenses depending on the type of care they need. That said, those who are low-income and qualify for Medicaid, a federal and state program that helps with medical costs for individuals and families with limited income and resources, will be happy to know that they can combine their Medicaid and Medicare benefits to help cover those costs.
All in all, Medicare will cover the cost of inpatient and many other treatments that can help individuals overcome an addiction to drugs or alcohol. However, coverage is not as straightforward as those offered by private health insurance providers. To learn more about how Medicare can aid in your addiction recovery, consider speaking with one of our knowledgeable addiction specialists today at 800-411-8019.