If you’re not sure what addiction treatment Medicare covers, we have answers. We’ve done the research to help you find Medicare-covered, high-quality care for drug or alcohol addiction.
What is Medicare, and how do I know if I have it?
Here’s the thing — insurance is confusing, and Medicare doesn’t make anything simpler by a few letters off from Medicaid, which is a totally different type of health insurance. So let’s start by defining some basic terms to help you understand what type of insurance you have.
Medicare: According to Medicare.gov, Medicare is the federal health insurance program for people who are 65 or older, or certain younger people with disabilities (and also people with end-stage renal disease). This is sometimes referred to as Original Medicare.
Medicare Advantage Plan: The federal government created Medicare advantage to provide people with more options for healthcare. Private health companies sell Medicare Advantage plans, which then cover Medicare services.
Medicaid: Medicaid offers health coverage to low-income adults and children, as well as people with disabilities. Medicaid is administered by the states. Learn more at Medicaid.gov.
What Addiction Treatment Does Medicare Cover?
Medicare may cover your addiction treatment. These are just guidelines — to understand your plan 100%, it’s important to reach out to Medicare or your Medicare Advantage plan directly. There are currently 3 factors involved in Medicare covering your addiction treatment:
- Your provider must state that treatment is medically necessary.
- You must receive services from a Medicare-approved provider or facility.
- Your provider must set up a plan of care. This is the clinician’s plan for your treatment.
If you’re looking for opioid addiction treatment in Michigan or California, Workit Health has a Medicare-approved digital program. If you’re unsure of what type of treatment you need, let’s break down the types of addiction treatment available, and whether or not Medicare covers them.
Does Medicare pay for outpatient treatment?
There are a few different types of outpatient addiction treatment, so determine what works for you and then check to see if your Medicare plan will cover it.
Some traditional treatment programs offer day or evening outpatient programs that focus on group therapy, counseling, and many of the same things as inpatient treatment, but in a less intensive setting.
Office-based addiction treatment is becoming more prevalent as we realize that addiction is a medical issue with medical treatment options available. This may include FDA-approved medication for addiction in an office setting, rather than in a hospital or methadone clinic. Workit Health offers medication for opioid addiction (Suboxone), now covered by some Medicare plans in Michigan and California. The program is conveniently online after the first appointment.
Additionally, opioid treatment programs should be covered by your Medicare plan. These are commonly referred to as methadone clinics, and offer on-site dosing of opioid addiction medications like methadone and buprenorphine (Suboxone).
If you’re receiving treatment from a Medicare-approved provider or facility, Part B of your Medicare plan should cover these services at 80% of an agreed-upon amount. This means that you will be responsible for 20% coinsurance. The outpatient center that you contact should have information on what exactly your costs would be.
Does Medicare cover residential treatment?
Residential treatment, often called inpatient care or rehab, is may be highly structured and supervised by a team of staff. Like any type of treatment, quality and content of these programs can vary so it’s important to evaluate all your options when choosing addiction treatment. It involves living in a community while focusing on your recovery, and the length of the stay can vary based on the program, severity of the addiction, or insurance coverage.
According to Medicareinteractive.org, your Medicare plan’s cost-sharing for inpatient care would apply to inpatient care and it would be covered under Part A.
How long you can stay in rehab seems to depend on how much you are able to pay — the first 60 days of treatment are covered with no co-insurance, but there is a $1,408 deductible for each stay period. That means you will be responsible for at least that deductible amount. If you need longer than 60 days (this would be longer than most inpatient treatment programs) you may accrue additional costs. Although rehab is the type of addiction treatment most people are familiar with, it isn’t the only option and there are many alternatives to rehab out there.
Does Medicare offer transportation to my appointments?
You may not have transportation to your appointment, or you may not be comfortable driving. If you’re in Michigan or California, Workit Health offers telemedicine addiction treatment which means you only have to come to an office a single time, and after that everything is done online.
If you’re not able to sign up for telemedicine treatment, there are options for transportation to medically necessary appointments for Medicare members. Although Original Medicare does not usually cover rides to appointments, other organizations and agencies, like your area on aging or senior center, may offer transportation. The rideshare company Lyft has begun partnering with Medicare Advantage plans to offer transportation in some areas, so if you’re covered by Medicare Advantage reach out to your plan for more specific transportation options.
Where can I get more information about what type of addiction treatment Medicare covers?
There are a number of resources online to help you understand Medicare and Medicare addiction treatment options:
Medicare.gov: This is the official US government site for Medicare. Here you can signup for Medicare and understand what Medicare covers. You can also find local assistance with your Medicare plan.
Medicare Interactive: Created by the Medicare Rights Center, this is a free and interactive tool that offers easy to understand answers to questions about Medicare.
Center for Medicare Advocacy: The Center for Medicare Advocacy is a national non-profit which provides education and legal assistance to people covered by Medicare. Anyone can contact the center for help.