Wednesday, September 21, 2022

Does Medicare Pay For Drug Rehab

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Statistics On Medicaid In The Us

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  • The Affordable Care Act of 2010 allows states to expand Medicaid coverage to nearly all low-income adults under the age of 65.6
  • Almost 12% of Medicaid recipients over the age of 18 have a substance use disorder.2
  • Every day, over 6,500 people seek emergency services for substance-related issues.2
  • Medicaid was the source of payment for more than 42% of all births in the U.S. in 2018.7
  • In 2017, Medicaid paid for more than 30% of long-term care for those in nursing care facilities and continuing care retirement communities.7

What Are Medicaid And Medicare

Some of the most commonly used methods for paying for drug and alcohol rehab, Medicaid and Medicare are federal- and state-funded health insurance programs. These insurance programs can provide free or low-cost drug and alcohol addiction treatment. Each program has different requirements for eligibility.

Medicare and Medicaid may cover part or all of your substance abuse treatment costs.

Every state has different rules for eligibility and treatment coverage. Rules for eligibility also change annually. If you were turned down for Medicaid or Medicare in the past, you could be eligible now.

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With just 30 days at a rehab center, you can get clean and sober, start therapy, join a support group, and learn ways to manage your cravings.

Rehab And Other Insurance

It is possible to have Medicaid supplement private insurance. In most cases, Medicaid acts as the payer of last resort for services. Generally, other responsible sources of payment are required to pay for medical costs before Medicaid will do so.15

As requirements can vary substantially from state to state, it will be imperative to work with individual treatment centers to determine what services are covered through individual policies and how much they will cost.

American Addiction Centers offers inpatient rehab in the United States. Call today to learn about our multiple nationwide treatment centers.

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Do I Need Health Insurance To Receive This Service

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

Does Medicare Cover Radiation For Cancer Treatment

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Radiation in small doses can be used in x-rays, such as x-rays of your teeth. Radiation in high doses can kill cancer cells and shrink tumors, according to NIH. Radiation cancer treatment damages the DNA of cancer cells, making them unable to divide and killing them. External beam radiation therapy treats a specific part of your body. Internal radiation therapy could be a local treatment or systemic therapy, traveling in the blood to tissues throughout the body. Medicare Part A generally covers radiation cancer treatment for hospital inpatients. Medicare Part B covers radiation therapy for outpatients of patients in freestanding clinics. Medicare Advantage plans also generally cover radiation.

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Verify That Your Doctors Order Includes The Required Information

To ensure Medicare coverage for your inpatient rehabilitation, your doctor will have to certify that you need:

  • access to a medical doctor 24 hours per day
  • frequent interaction with a doctor during your recovery
  • access to a registered nurse with a specialty in rehabilitation services
  • therapy for at least 3 hours per day, 5 days per week
  • a multidisciplinary team to care for you, including a doctor, rehabilitation nurse, and at least one therapist

Does Medicare Cover Methadone

OTPs are the only locations where people addicted to opioids can receive methadone as part of their treatment. Under the new coverage rules, Medicare Part B may cover:

  • Opioid treatment medications that are approved by the U.S. Food and Drug Administration such as methadone
  • The administration of the treatment medications
  • Counseling for substance use
  • Intake activities
  • Periodic assessments

Medicaid already provided coverage of methadone treatment for dual-eligible beneficiaries . Under the new rule, Medicare will act as the primary payer for OTP services.

The new rule comes as a result of the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. Under the legislation, Congress expanded access to opioid use disorder treatment services and authorized the creation of Medicares OTP benefit.

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Can Veterans Qualify For Medicaid

Yes, U.S. veterans can utilize VA services and still be eligible for Medicaid benefits.18 In fact, Medicaid is a critical source of health coverage for many veterans. Almost 1 out of every 10 non-elderly veterans have Medicaid, and almost 50% get their health coverage exclusively through Medicaid.19

There are more than 9 million non-elderly veterans in the U.S. Of those covered by Medicaid, 54% have a disability and over 40% have 2 or more chronic health conditions. Approximately 11% suffer from mental illness and 12% have a substance use disorder. Veterans also experience homelessness more than the general population.19

Medicaid is a vital component of the long-term care of military veterans.

Medicare And Drug Addiction Treatment

What Does Medicare Actually Cover?

Medicare provides some coverage for drug and alcohol rehabilitation treatment, as long as the services are determined to be medically necessary, a plan of care is established by the provider and the services are received at a Medicare-approved facility or from a Medicare-approved provider.

Medicare Part A provides coverage for inpatient treatment received at a hospital or rehab center. Part B provides coverage for outpatient treatment from a clinic or hospital outpatient center.

Some Medicare Part D prescription drug plans may help pay for drugs that are considered medically necessary to treat substance use disorders.

Medicare Advantage plans, provides coverage for everything covered by Medicare Part A and Part B, and some may also provide coverage for prescription drugs used to treat substance use.

A licensed insurance agent can help you compare Medicare Advantage plans and Medicare Part D prescription drugs plans in your area that may help cover prescription drugs used to treat addiction. You can also compare plans online, with no obligation to enroll.

Find Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

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Can I Have Dual Eligibility For Medicaid And Medicare

A person may be enrolled in both Medicaid and Medicare at the same time as long as they meet the eligibility requirements for both. Someone who has both types of coverage is known as a dual-eligible beneficiary.9 Medicare typically pays for Medicare covered services first and then Medicaid tends to cover services Medicare does not cover. In 2018, 12.2 million individuals were simultaneously enrolled in both Medicaid and Medicare.10

Does Medicare Cover Immunotherapy For Cancer Treatment

The immune system is made up of white blood cells and organs and tissues of the lymph system, according to the National Institute of Health. Immunotherapy helps your immune system fight cancer. Immunotherapy includes medications that cause an immune response which kills cancer cells. Immunotherapy also includes treatment vaccines which boost the immune systems response to cancer cells. Medicare may cover immunotherapy cancer treatment if it determined to be medically necessary.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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What Costs Should You Expect To Pay

If youre enrolled in original Medicare in 2020, youll pay the following costs during each benefit period:

  • Days 1 through 60. Youll be responsible for a $1,364 deductible. If you transfer to the rehab facility immediately after your hospital stay and meet your deductible there, you wont have to pay a second deductible because youll still be in a single benefit period. The same is true if youre admitted to a rehab facility within 60 days of your hospital stay.
  • Days 61 through 90. During this period, youll owe a daily coinsurance amount of $341.
  • Day 91 and onward. Youll pay $682 coinsurance for each of your lifetime reserve days. You have 60 lifetime reserve days. After youve used them all, youre responsible for all costs.

How To Find Rehabs That Accept Medicaid Or Medicare

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Finding providers who accept Medicaid or Medicare isnt always easy. It will require research and communication with Medicare and Medicaid representatives to determine what parts of substance abuse treatment are covered.

The Substance Abuse and Mental Health Services Administration offers a website focused on helping you find treatment.6 At FindTreatment.gov, you can search for treatment options near you.7 When you search, you can choose the payment options available for you, including Medicaid or Medicare. If you have both, Medicare pays first, so you can select that option.

You can choose from a variety of other alternatives as well. For instance, you can search for an inpatient or outpatient program specifically, or a program focused on veterans or LGBTQ people.

While you may not find a program that checks all your boxes, you can find the one thats best for your situation. This may mean prioritizing parts of treatment based on need. For example, if you are looking for medical detox, this is a great way to start narrowing down facilities. Finding a facility that offers medical detox and accepts Medicare or Medicaid can be an important start to finding treatment. For more information about how to find state-funded rehab programs in your area, review our guides below:

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Does Medicare Cover Mental Health Care

Medicare covers mental health services, both on an inpatient and an outpatient basis. Medicare covers counseling, psychiatric evaluations, hospitalizations, as well as certain injectable medications.1 ,2 ,

For example, for outpatient treatment, under Part B, Medicare will typically cover:2

  • Individual and group therapy.
  • Medication that you cant give yourself, such as injections.
  • An annual mental health check-up.

Medicare will cover inpatient treatment if medically necessary.3 If your doctor wants you to get a treatment that Medicare does not cover, and you agree, you may be responsible for the cost. You may also be responsible for some of the cost if Medicare does not provide coverage for the service as often as your doctor believes that you need it. 3 It is important to know that not every provider who falls under one of these categories is automatically eligible to be reimbursed through Medicare. For Medicare to pay the cost of these services, the provider must accept Medicare assignment. 2 In addition, you typically have a 20% co-pay for services, after you have met your deductible.2

Medicare Parts & Breakdowns

The following are the breakdowns of Medicare parts:3

  • Part A helps with payment for inpatient treatment at a hospital or inpatient rehab center.
  • Part B helps with payment for outpatient treatment services through a clinic or a hospital outpatient center.
  • Part C refers to Medicare Advantage Plans that are offered by private companies and are approved my Medicare. These plans may include Parts A, B, and D and may even cover more benefits outside of original Medicare.
  • Part D can be used to help pay for drugs and medications that are medically necessary to treat substance use disorders.
  • Medicare also covers Screening, Brief Intervention, and Referral to Treatment services provided in a doctors office.

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Sbirt And Alcohol Risk Screening And Counseling

Screening, Brief Intervention, and Referral to Treatment is a screening and intervention technique that can help identify individuals at risk of experiencing alcohol related health issues prior to the need for more comprehensive substance abuse treatment. This type of intervention can be covered by Medicare as a preventive measure when someone in a primary care setting shows signs of substance abuse.5

The process includes:5

  • A screening to assess whether the person has risky substance use behaviors.
  • A brief intervention in which the provider has a conversation with the person about their substance abuse and offers feedback and advice.
  • Referral to services, therapy, or treatment for people whose screening suggests a need for further services.

Medicare For Drug And Alcohol Rehab

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Medicare is available to anyone over 65 years old and those with disabilities. Medicare is available for a monthly premium, which is based on the recipients income. People who earn less pay lower premiums.

Medicare can cover the costs of inpatient and outpatient drug rehabilitation. It consists of four parts that cover different parts of addiction recovery programs.

The Four Parts of Medicare
Part A Insurance for Hospital Stays. Medicare Part A can help pay for inpatient rehabilitation. Part A covers up to 60 days in treatment without a co-insurance payment. People using Part A do have to pay a deductible. Medicare only covers 190 days of inpatient care for a persons lifetime.
Part B Medical Insurance. Part B can cover outpatient care for addicted people. Medicare Part B covers up to 80 percent of these costs. Part B covers outpatient care, therapy, drugs administered via clinics and professional interventions. Part B also covers treatment for co-occurring disorders like depression.
Part C Medicare-approved Private Insurance. People who want more benefits under Medicare can opt for Part C. Out-of-pocket costs and coverage is different and may be more expensive.
Part D Prescription Insurance. Medicare Part D can help cover the costs of addiction medications. People in recovery often need medication to manage withdrawal symptoms and cravings. These medications increase the likelihood of staying sober.

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Medicare Coverage For Substance Use Disorder

Medicare Part A covers inpatient treatment and Medicare Part B covers outpatient services.3 When you receive outpatient treatment, Medicare Part B considers several types of providers as generally eligible to provide necessary and reasonable substance use disorder treatment:1

  • Physicians
  • Clinical social workers
  • Clinical nurse specialists

If you need medication to treat substance abuse or mental health disorders, this coverage is provided through Medicare Part D. For example, Suboxone for an opioid use disorder is covered under Medicare Part D for patients who need Suboxone according to their physician.1

Within these treatment options for substance use disorders, there are numerous interventions that Medicare will cover, depending on the type of program. In a PHP, for example, Medicare will also cover activity therapy, family therapy, patient education, and occupational therapy.1

Medicare does not cover 100% of your costs for treatment. Medicare does have deductibles. For example, for inpatient treatment, a person with Medicare is required to pay a deductible of $1,484 each benefit period and after day 61 of inpatient treatment, a $371 copay for each additional day of treatment.3 For outpatient treatments, you pay 20% of the cost.2

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  • In Victoria, the state government funds non-government organisations to deliver alcohol and other drug treatment services for free or at a reduced cost to eligible Medicare card holders.
  • Private alcohol and other drug treatment services can be accessed directly, but this usually means you will have to pay for the services in full.
  • Check with the provider about their costs before signing up to a program.

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Medicare Covered Drug Rehab Centers And Treatment Hotline

Medicare is the federal governments health insurance program for certain people. It provides a wide range of medical healthcare solutions for Americans, including coverage for people dealing with drug or alcohol addiction.1 If you meet the criteria for Medicare coverage , you can access the benefits.

If youre dealing with a substance abuse issue, you probably have questions about your Medicare rehab coverage. Its important to have an understanding of Medicare drug treatment so that you can begin the recovery process. Delaying addiction treatment will only lead to your condition worsening. So, let look a bit closer at how Medicare manages substance addiction issues.

Will Medicare Advantage Cover Addiction Treatment

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Medicare Advantage plans have to cover the same addiction treatment as Medicare. Many Medicare Advantage plans are health maintenance organizations , which require you to seek care from an in-network provider. This may limit the care providers from whom you can get outpatient services like therapy or inpatient services like addiction rehab. You may have to get a diagnosis from a primary care provider or get a referral to treatment.

Some examples of the types of services Medicare Advantage plans may cover include:

  • hospitalization following a drug or alcohol overdose
  • inpatient rehab
  • outpatient rehab
  • therapy
  • psychiatric care, such as a consultation with a psychiatrist or a prescription for anti-addiction or withdrawal medication

Medicare Advantage plans also include special needs plans . SNPs cater to people with similar or related conditions. Some SNPs support people with chronic mental health issues, such as substance abuse. These plans may offer additional cost savings, as well as access to a wider network of addiction experts.

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Medicare Advantage Plans Also Cover Rehab

Medicare Advantage plans are required to provide the same benefits as Original Medicare. Many of these privately sold plans may also offer additional benefits not covered by Original Medicare, such as prescription drug coverage.

This means that a Medicare Advantage plan will pay for your qualified rehab in the same ways that Medicare Part A and Part B would. You could potentially find a Medicare Advantage plan that also offers other benefits that you find helpful but arent covered by Original Medicare.

Find Medicare Advantage plan benefits in your area

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

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