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Drug Treatment Programs and Medicare Coverage

Medicare is an insurance program that provides coverage for the cost of drug and alcohol rehab. However, there are a specific set of rules that are used to determine not only eligibility for the coverage, but what exactly is and is not covered under this specific type of service.

It is important to keep in mind that you should read the coverage information that is provided to you in the handbook or other pamphlet materials when you signed up for Medicare. Additionally, some drug, alcohol, and addiction treatment services are not covered by Medicare at all.

Contact your specific Medicare agency to find out more information regarding the specific coverage options you have.

The costs that are associated with this type of addiction treatment is important to consider for anyone. The thought of having to pay too much out of pocket may hinder the ability to seek out and get the help that is needed.

If you feel that you are unable to pay for the costs associated with addiction treatment, Medicare may be able to help you.

You may be eligible for this type of Medicare coverage if:

  • You have a disability and are younger than 65
  • You are over 65 years of age
  • You are under the age of 65 and are going through end stage renal disease

Those with low incomes sometimes have Medicaid to supplement the Medicare coverage. Both can provide coverage for addiction treatments that may be necessary.

Learn more about the basics associated with Medicare and obtaining the addiction treatment coverage necessary.

Using Medicare to Cover the Costs of Addiction Treatment

Medicare can provide coverage for the costs of addiction treatment. However, the addiction treatment has to meet a set of specific qualities.

  • The services must be medically necessary, and a physician has to state such.
  • The physician that you see regularly has to set up a plan of care.
  • The facility must be a Medicare-approved facility.

There are different parts that Medicare has that provides a series of coverage options that break down the services and what they cover.

Part A, Part B, and Part D.

Medicare also provides comprehensive screenings, intervention services and referral to treatment services for doctor’s offices to use for patients.

Learning which part covers which service can be the most difficult part.

Medicare Part A – Inpatient Treatment

This is hospital treatment coverage essentially. It provides inpatient care for those that are being treated for substance abuse. The coverage can also be given through approved nursing facilities. Hospice and home health care are both covered services, as well.

Part A will also cover services for those that need substance abuse help if the services are necessary and reasonable.

However, under this part of Medicare, the person cannot go over 190 days of treatment through a specialty hospital. This is how many days a covered individual gets in a lifetime.

Inpatient addiction rehabilitation programs, as well as follow-up, ongoing care and support can provide the necessary help that a person needs to overcome an addiction. Whether short or long-term, the addiction treatment can include a series of steps including detox, group and individual therapy, education, prevention, meetings and more.

 Medicare Part B – Outpatient Treatment

Part B provides outpatient care and support for those covered individuals. These programs do not require the covered individual to be in the facility and get care while staying or living in the facility.

Partial hospitalization is a service that is also offered and covered at an approved hospital or other mental health care center. These programs are more intensive and extensive, but they provide more comprehensive covered care.

Partial hospitalization must be approved and recommended through the physician and the person must be committed to at least 20 hours per week.

These treatments can include therapy sessions individually, group, activity, occupational, and behavioral. Patient education is also provided, as well as prevention for drug use. Medications that have to be administered through a program and diagnostic services.

Alcohol Risk Screening and Counseling Services – SBIRT

This program also provides alcohol screening for those that might not qualify for the misuse coverage, as they are not labeled as a heavy alcoholic, but if they are deemed to have an alcohol problem during the screening, they can get up to four counseling sessions per calendar year.

This process is open to those that request it or those that have had prior issues with alcohol. This is an intervention program that is usually used when an individual is at risk for having a serious dependency issue. When someone shows signs of substance abuse, more rigorous treatment may be necessary. This is what is looked into during the sessions and screening.

A screening is done on the individual to see if they are at risk for this type of substance abuse.

An intervention with the person about their abuse, about those close to them, providing feedback and giving the person a chance to realize they have a problem.

The referral of services that provide further help to the individual are also given during this time, including therapy or treatment services.

Medicare Part D – Medication Coverage

Medicare Part D can help cover medications that may be necessary to help treat the substance abuse disorders the covered individual needs. Some of these medications, such as Suboxone, are prescribed for those that are going through opioid dependency.

This Part D may not cover all types of drugs that may be prescribed or needed, but they are required, under law, to provide coverage for any prescriptions such as antipsychotic, anticonvulsant or antidepressant drugs that are required for mental health treatment.

There is a specific listing of medications that are covered under this type of healthcare plan. Making sure that the prescription drug that you are being prescribed is on this list is important to ensure that it is a drug that is going to be covered.

Get More Help

If you feel that you need more help, contact your specific Medicare office directly. They will be better able to provide answers to any and all of the questions that you may have regarding coverage and substance abuse. Substance abuse and mental health services are becoming a more widely covered service in the healthcare field.

 

 

Resources

https://www.medicare.gov/eligibilitypremiumcalc/

https://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-eligibility.html

https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html