Medicare is a federally funded program that provides affordable health insurance to people over the age of 65 or those who meet other specific eligibility requirements.1 (what’s Medicare) Medicare is divided into several different parts that offer coverage for various aspects of medical care, including hospital treatment (Part A coverage), medical and other outpatient care (Part B coverage), and prescription medications (Part D coverage).1 (what are the parts) Each of these parts plays a different role in how Medicare benefits pay for rehab and other substance abuse treatment services. Depending on the type of Medicare plan that you have, you may have to choose a treatment provider from within a network for your treatment to be covered, and if so, choosing a provider from outside of the network can result in higher out-of-pocket costs.2 In this article, you will learn more about:
- Medicare and rehab coverage for substance use disorders.
- Medicare and rehabilitation benefit coverage for co-occurring substance use disorders and mental health disorders.
- Whether there are limits on how long treatment is covered for Medicare inpatient rehab facilities, and what they are.
- What the requirements are to be eligible for Medicare coverage.
- How to find alcohol and drug rehab centers that accept Medicare.
What will Medicare cover?
A full range of Medicare rehabilitation coverage is available, as long as the provider can show that the services are necessary and reasonable for the treatment of a substance use disorder.3 (p1) Medicare rehab coverage may pay for some or all of the cost of the following types of treatment:3 (p1-2, 4), 4 (p4-6, 21), 5 (p4, 25-27), 6 (mental health care), 7 (mental health care), 8 (what it is), 9 (opioid use disorder, your costs, what it is)
- Inpatient or residential rehab treatment programs, where you stay at a facility while receiving treatment. This may also include detoxification, a type of treatment where staff monitors you closely for the duration of treatment and medications may be provided under supervision in order to manage symptoms of withdrawal. An inpatient rehab program generally lasts about 4 weeks, typically shorter than a residential program, which can last 6 months or longer, depending on your needs.
- Partial hospitalization programs (PHP), which are an intensive form of outpatient treatment involving at least 20 hours of treatment per week. This type of program can be used as a bridge between inpatient and outpatient treatment, such as by people who need the high level of care offered by inpatient programs but don’t need to be supervised around the clock, or those who need a higher level of care than offered in intensive outpatient or standard outpatient treatment. This may also be a good option for people with co-occurring disorders.
- Intensive outpatient programs (IOP), which are a step down from PHP. You will receive fewer hours of treatment per week than at a PHP, but this type of program is more structured and intensive than a standard outpatient program. Counseling is offered in group and individual sessions.
- Outpatient rehab, where you receive group and individual counseling at a facility during scheduled sessions while living at home and having the ability to attend work or school outside of treatment.
- Medication-assisted treatment (MAT), which combines therapy and the use of medication to assist in maintaining sobriety from specific substances, such as opioids and alcohol. These may also be known as office-based opioid use disorder treatment or opioid treatment programs.
Does Medicare Cover Mental Health Care?
Mental illness and substance abuse disorders are more common to occur together and are known as dual diagnosis or co-occurring disorders.10 (p7) In 2019, 9.5 million Americans aged 18 or over had co-occurring disorders.11 (p46) Since mental illness and substance use disorders can each affect and influence the course of the other disorder, potentially making symptoms worse, integrated treatment has been identified as the best way to treat co-occurring disorders.10 (p12, 189) Integrated treatment involves addressing both disorders and how they affect various areas of your life, using therapy addressing substance use and mental health, medication, vocational services, and any other supports that may be needed.10 (p15, 186, 189, 192) Medicare rehab facilities may also offer mental health services as part of integrated treatment plans, and Medicare does approve mental health treatment services either individually or as part of substance use disorder treatment programs.6 (mental health care), 7 (mental health care)
How long does Medicare Cover Rehab?
In general, spending a longer period of time in treatment for substance use disorders have been shown to increase the likelihood of abstinence and long-term recovery.5 (p4, 12) Spending a minimum of 90 days in a Medicare rehab, whether it is inpatient, outpatient, or some combination of treatment types, can improve your treatment outcomes.5 (p4, 12) However, it is important to remember that everyone makes progress in treatment at their own speed, depending on how severe their substance use disorder is, if they have co-occurring disorders or other issues present, and a range of other factors.5 (p4, 12)
Medicare inpatient benefits may be time-limited, depending on the setting in which you receive them.6 (note, things to know) While there aren’t any limits on how long you can spend in a general hospital receiving mental health care, Medicare rehab rules allow you to only attend 190 days of treatment as an inpatient in a psychiatric hospital for as long as you have Medicare.6 (notes, things to know) For Medicare rehab centers that provide outpatient treatment services or office-based opioid use disorder treatment, the length of time that Medicare will cover treatment depends on how long your treatment is deemed reasonable and necessary.3 (p1) For more information about Medicare benefits, you can visit Medicare and the Marketplace and the Medicare website here.
What are Medicare eligibility requirements?
There are certain eligibility requirements that need to be met in order for you to qualify for Medicare.12 You would be eligible for Medicare if you fall into one of the categories below: 1 (what’s Medicare), 12
- If you are 65 years of age or older.
- If you are under age 65 but are disabled.
- If you are under age 65 and have End-Stage Renal Disease (ESRD), which is permanent kidney failure that causes you to need either dialysis or a kidney transplant.
Depending on your work history and circumstances, you may not have to pay premiums for Part A (hospital coverage), but everyone is required to pay for Part B (medical coverage) premiums.12 Everyone with Medicare has Part D (prescription drug) coverage.12 You can learn more about your eligibility and what your expected premiums might be by visiting this website.
Medicare sponsored rehab
If you want to find out more about what your Medicare benefits will cover, you can contact Medicare by calling the telephone number on your Medicare card or logging into an online account here. You can also find a Medicare alcohol rehab or drug treatment center by searching for approved providers here. The Substance Abuse and Mental Health Services Administration operates a treatment provider search that you can access here, which allows you to search according to treatment type, insurance, and personal preferences, such as finding dual diagnosis treatment centers that accept Medicare, Medicare drug programs that provide medication to treat opioid use disorders, or programs that specialize in treating certain populations such as LGBTQ, seniors, or veterans.
American Addiction Centers is one of the country’s foremost providers of treatment for substance use disorders and dual diagnosis treatment, offering comprehensive services from detox to outpatient therapy and everything in between. With a network of facilities across the country, American Addiction Centers strives to make treatment accessible to anyone who needs help. Our free, confidential helpline is available 24/7 at (888) 553-7450, and an admissions navigator can help you learn more about the treatment process, whether American Addiction Centers accepts your Medicare coverage, and how to talk about your substance use with your family. In addition, they can help you understand the options available to you in financing the cost of your treatment, especially if your insurance doesn’t cover the full cost of your treatment, and assist you in discussing this with your family or loved ones. Our admissions coordinators can guide you towards a Medicare rehab facility that will best meet your needs and get you started on the road to recovery.
- gov. What’s Medicare?
- gov. Health Maintenance Organization (HMO).
- Centers for Medicare and Medicaid Services. (2016). Medicare coverage of substance abuse services.
- Centers for Medicare and Medicaid Services. (2021). Medicare mental health.
- National Institute of Drug Abuse. (2018). Principles of drug abuse treatment: A research-based guide. (Third edition).
- gov. Mental health care (inpatient).
- gov. Mental health care (outpatient).
- gov. Mental health care (partial hospitalization).
- gov. Opioid use disorder treatment services.
- Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.
- Substance Abuse and Mental Health Services Administration. (2020). Key substance abuse and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
- S. Department of Health and Human Services. Who is eligible for Medicare?