Will Medicare Cover Substance Abuse Treatment?

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Did you know? Medicare can provide coverage for many substance abuse treatments, including:

  • Inpatient rehab
  • Outpatient counseling
  • Medication 

Another option is a Partial Hospitalization Program (PHP) — which Medicare covers for substance abuse treatment. To qualify, your doctor must confirm that you need 20 or more hours of weekly therapeutic services. Then, your doctor will need to submit a treatment plan.  

Here’s a more in-depth look at the parts of Medicare that pay for substance abuse programs. 

Medicare and Substance Abuse Counseling

Medicare Part A pays for substance abuse counseling while you’re an inpatient. 

Medicare Part B includes outpatient substance abuse counseling — when it’s provided by a mental health doctor — in the doctor’s office, a hospital outpatient setting, or a mental health center. Medicare covers individual OR group sessions, but it doesn’t cover peer counseling or support groups

Part A and Part B Coverage – Continued

Part A may cover the cost of your stay in an inpatient facility and any inpatient medicine for treatment. Part A copays, deductibles, and coinsurance amounts may apply.  

Additionally, Part B covers medicines that a doctor gives you (they can’t be self-administered). 

If telehealth counseling is part of an opioid treatment program, Medicare will also pay for this. 

Related Post: Am I Eligible for Medicare? 

Medicare Advantage Coverage for Substance Abuse

People with a Medicare Advantage plan get access to substance abuse treatment, but they should use an in-network doctor. Going out of the network means you pay all costs. 

Some special needs plans help folks with certain chronic issues like mental health and substance abuse. Plan options vary by county. 

Medicare Part D and Substance Abuse Medications

You need a separate Part D plan for prescriptions to be covered. Part D will cover prescription substance abuse meds taken at home. Each plan has a schedule of the drugs covered and their cost. Coverage for a certain medication depends on your plan and whether you use one of their chosen pharmacies. 

What About Drug Rehab?

Yes, Medicare’s coverage for substance abuse treatment INCLUDES rehab for all kinds of drug addiction. Coverage extends to people with alcohol and illegal drug addiction, as well as an addiction to prescription drugs.

With that in mind, overcoming addiction may require months in inpatient rehab and years of outpatient therapy. Those with addictions often struggle with mental health problems. While Medicare covers addiction treatment, you might pay copays, coinsurance, and deductibles. People with a Medigap policy will pay less out of pocket than those who don’t.

Does Medicare Cover Methadone Treatment?

Methadone is the most well-known opioid treatment. Part A will cover methadone if it’s administered in an inpatient hospital setting. For those who aren’t inpatients, you have to visit an opioid treatment center for daily doses — Methadone is highly-controlled, and you can’t get it at a regular pharmacy. 

The important thing to know is that Medicare covers methadone and other opioid treatments for people who enroll.   

Related Post: Medicare and Medicaid in a Nutshell

When Medicare May Deny Your Claim

Medicare can deny your claim if your treatment is unnecessary or if you see a doctor that doesn’t take Medicare. 

If you have a Medigap policy, those plans occasionally deny claims on the basis of pre-existing conditions. If you or a loved one were diagnosed with a substance abuse disorder before signing up, your plan might reject coverage.    

Also, some Advantage plans may deny claims if your physician isn’t in the provider network. 

A Medicare Supplement Plan Can Help

Substance abuse treatment can be a lengthy, difficult path, and the costs can pile up. But with a Medicare Supplement (Medigap) plan, these expenses become manageable — by obtaining cost-sharing. 

An agent at Bobby Brock Insurance can answer your questions and compare Medigap policy options where you live. The best part? We do it for FREE, saving you time AND money. Call (662) 844-3300 or fill out our online form for a free quote. 

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Justin Brock

President & CEO of Bobby Brock Insurance