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.
- Written by Terry Turner
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).
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Matt Mauney
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
Read More- Published: March 25, 2021
- Updated: November 1, 2022
- 7 min read time
- This page features 6 Cited Research Articles
- Edited By
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% of the Medicare-approved cost of your treatment after you meet your deductible. But Medicare pays 100% 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.
How Long Does Medicare Pay for Drug or Alcohol Rehab?
How long Medicare pays for your rehab treatment depends on the type of treatment you receive — inpatient or outpatient.
If your treatment takes place in a specialty psychiatric hospital, Medicare Part A will pay for no more than 190 days of treatment in your entire lifetime.
If your treatment takes place in a hospital, acute care hospital, inpatient rehab center or other typical inpatient settings, the standard Medicare Part A deductible and coinsurance costs apply. These increase the longer you stay in the facility.
| Days in Rehab | Your Costs |
|---|---|
| Days 1 through 60 | $1,600 deductible (You don’t have to pay if you’ve already paid a deductible for the existing benefit period.) |
| Days 61 through 90 | $400 coinsurance per day |
| Days 91 and beyond | $800 coinsurance per each lifetime deserve day (Up to 60 days in your lifetime) |
| Each day after lifetime reserve days are exhausted | All costs |
A benefit period under Medicare starts the day you are admitted to an inpatient facility other than a psychiatric hospital and continues for 60 consecutive days after you’ve been discharged without being readmitted.
Lifetime reserve days are extra days Medicare gives you over the course of your lifetime beyond 90 days. Once used up, they’re gone.
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% of the Medicare-approved cost for your doctor or other health care provider’s services and your Part B deductible still applies.
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6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- 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
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