Does Medicare Cover Alcoholism and Substance Use Disorder Treatment?
Medicare will cover alcoholism and substance abuse disorder treatment if you are enrolled in Medicare and meet certain eligibility requirements. Both inpatient and outpatient treatment is covered, but it must be medically necessary and done by a Medicare-approved provider.
Medicare Coverage for Alcoholism and Substance Use Disorder
Original Medicare — Medicare Part A and Part B — covers inpatient and outpatient treatment of alcoholism and substance use disorder. Medicare Part B also covers certain opioid use disorder treatments.
Medicare Advantage plans must cover everything Original Medicare covers. You may still have to pay some out-of-pocket costs for treatment with Original Medicare and Medicare Advantage plans.
Medicare Part D prescription drug plans may not cover all medications you require for treatment.
- Medicare Part A
- Medicare Part A covers inpatient treatment for alcoholism and substance use disorder if you are hospitalized or in a rehab facility that is approved by Medicare. You are still responsible for your Part A deductible. You will also have to pay coinsurance for each day beyond 60 that you remain in the hospital or rehab facility.
- Medicare Part B
- Medicare Part B covers outpatient treatment in a clinic, hospital outpatient facility or an opioid treatment program — sometimes called methadone clinics. You are responsible for your Part B deductible and coinsurance, which is typically 20 percent of the Medicare-approved cost of your treatment after you meet your deductible. But Medicare pays 100 percent of the costs after your deductible if you get them from an opioid treatment program that’s enrolled in Medicare.
- Medicare Part D
- Medicare Part D prescription drug plans are sold by private insurers and drug coverage can vary from plan to plan. Not all medications are covered by Part D prescription drug plans, but may be covered by Medicare Part A or Part B. You should check with your plan — and your treatment provider — to see which drugs necessary for your treatment may not be covered.
- Medicare Advantage Plans
- Medicare Advantage plans are sold by private insurers. Everything covered by Medicare Part A and Part B must be covered by a Medicare Advantage plan. But you may have to use a treatment provider in the plans network or you will have to pay extra. Contact your plan to locate in-network providers that treat mental health, alcoholism and substance abuse before committing to treatment.
What Is Alcohol and Substance Abuse Disorder Treatment?
Alcohol and substance abuse disorder treatment is specialized medical and mental health care that addresses chemical dependency.
It is provided by specially trained professionals, certified or licensed in the field of substance abuse treatment and counseling.
Once you enter a treatment program, you will typically be assigned a treatment team of these professionals who best fit your needs. A team may consist of medical doctors, psychiatrists, psychologists, nurses, social workers, counselors or other professionals.
Your team will work together and with you to create an effective treatment plan customized to your condition.
- Inpatient Treatment
- Inpatient treatment typically happens through special hospital or medical clinic units. They seldom happen in a regular hospital. These programs offer detox and rehabilitation services. People with serious medical problems, abuse issues or mental health conditions are the more likely to receive this type of care.
- Residential Treatment Programs
- These programs have you live onsite in a residential setting, including therapeutic community settings. You may remain for treatment from a month to a year or more to receive your treatment. These are generally best for people who have little or no family support or no stable living or employment situation.
- Partial Hospitalization or Day Treatment
- Provided in hospitals or clinics, you will live at home but go to the facility for four to eight hours of treatment per day. Your treatment will usually last three months or more. These programs work best for people with a stable and supportive home environment.
- Outpatient and Intensive Outpatient Programs
- These may be provided in health or medical clinics, community or other mental health clinics, counselor’s offices or your local health department. You live at home and attend treatment sessions, often at night to avoid conflicts with school or work. You may have to attend daily or as little as once a week depending on your condition.
- Intensive Outpatient Treatment
- These programs allow you to live at home, but you have to attend nine to 20 hours of treatment sessions per week. Treatment typically lasts from two months to a year. People in this setting need a stable and supportive family or friends and must have reliable transportation to and from sessions.
- Opioid Treatment Programs
- Also called methadone clinics, these programs use medication to assist in treating your dependency on opioids — heroin, OxyContin, Vicodin and other opioids. The programs use counseling and medications — such as methadone or LAAM — to help people with their opioid dependence.
Substance abuse disorders can affect virtually all parts of your life. Treating it can take months or years.
Alcohol and substance abuse disorder treatment addresses more than just your dependency. It works to counsel you on your behavior, provide education on dependency issues to you and your family members, establish a customized treatment plan for you and establish long-term follow ups to monitor your progress after leaving the program.
Outpatient vs. Inpatient Alcohol and Substance Abuse Treatment
Medicare Part A covers inpatient alcohol and substance abuse treatment while Medicare Part B covers outpatient treatment.
Inpatient typically means care you receive after you’ve been formally admitted to a hospital. Outpatient means any treatment you may receive without being formally admitted to a hospital.
Medicare Part A helps pay for treatment you receive if you have to be hospitalized for your condition. It also covers care you receive in a specialized rehabilitation hospital or rehab facility where you will stay during your treatment.
- Inpatient hospitalization
- Inpatient drug rehab services
- Care received from doctors and nurses in a hospital setting
- Medications needed for your treatment in a hospital setting
Medicare Part B medical insurance covers your treatment if you receive it in an outpatient setting such as a clinic, hospital outpatient department or an opioid treatment program.
- Alcohol misuse screenings
- Outpatient hospital services
- Partial hospitalization in the event of intensive drug rehab
- Psychiatric evaluations
- Individual or group therapy
Medicare Part B will also help cover your telehealth treatment if you meet certain requirements. You are still responsible for 20 percent of the Medicare-approved cost for your doctor or other health care provider’s services and your Part B deductible still applies.
5 Cited Research Articles
- Substance Abuse and Mental Health Services Administration. (2021, January 28). National Helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline
- Substance Abuse and Mental Health Services Administration. (2014). What Is Substance Abuse Treatment? A Booklet for Families. Retrieved from https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4126.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Alcohol Misuse Screenings and Counseling. Retrieved from https://www.medicare.gov/coverage/alcohol-misuse-screenings-counseling
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Opioid Use Disorder Treatment Services. Retrieved from https://www.medicare.gov/coverage/opioid-use-disorder-treatment-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Telehealth. Retrieved from https://www.medicare.gov/coverage/telehealth