How Long Will It Last
The first necessary thing is to understand what a benefit period is. Essentially, this period begins when you are admitted as an inpatient, and it ends when you are out of the hospital for 60 days in a row. With this in mind:
- For days one to 60 of inpatient care per benefit period, Medicare covers most inpatient care costs beyond 20 percent of the Medicare-approved amount for mental health services.
- For days 61 to 90 of inpatient care per benefit period, you will be required to pay $341 coinsurance per day in addition to costs you were already paying.
- For days 91+ of inpatient care per benefit period, you begin tapping into your lifetime reserve days. You will be paying $682 in coinsurance per day now.
- You only have 60 lifetime reserve days ever. After that, going over 90 days in a benefit period means you are covering all costs of inpatient treatment. This will be prohibitively expensive to most people. If it isnt for you, you should at least find a quality insurance plan beyond Medicare if it is expected that you will reach this limit.
Once a benefit period is over, and if a new one begins, this cycle resets, with the exception of spent lifetime reserve days. You will again have 60 more days of inpatient care with no coinsurance payment and so on.
Does Medicare Cover Addiction Treatment Like Drug And Alcohol Rehab
You may be pleased to know that the simple answer to the question: Does Medicare cover drug rehab? is yes. That said, certain conditions must be met before Medicare will provide coverage for this type of treatment. Those conditions are as follows:
- One must be eligible for Medicare to receive treatment.
- Your provider must deem that addiction treatment is medically necessary.
- Your care must come from a Medicare-approved facility or from a Medicare approved provider.
- Your provider must set up your plan of care
One typically becomes eligible for Medicare upon attaining the age of 65. In addition, one can become eligible for Medicare coverage upon the diagnosis of certain disabilities or diseases such as end stage renal disease.
The four different parts of Medicare can all contribute to addiction treatment in different ways. Lets take a closer look at how each part of Medicare works together to provide coverage for addiction treatment.
Addiction Treatment Under Medicare Part B
Medicare Part B is designed to assist in paying fore the costs associated with outpatient treatment for drug and alcohol rehabilitation. Programs covered under Part B do not require residence in a treatment facility.
Under Part B, a physician must certify that a Medicare beneficiary requires the treatment they receive, including partial hospitalization programs. Services offered as part of partial hospitalization programs often include the following:
- Individual and group therapy
- Therapeutic drugs that cannot be self-administered
- Medically necessary diagnostic services for mental health
In addition, Medicare Part B may cover alcohol misuse assessment once per year if you are an adult who does drink but does not meet the criteria for an alcohol use disorder.
How Long Does Medicare Cover Rehab
Treatment for substance abuse is designed to help people experiencing addiction by helping them to stop using drugs and return to productive, functioning lives. Most people that get into and remain in treatment can stop using drugs and see improvements in their occupational, social, and psychological functioning.8 How Effective is Drug Addiction Treatment?However, rehabilitation treatment plans must be individualized, and the type of treatment that you will receive depends on the extent and nature of your problem and the types of treatment services that will best help you to address underlying problems. Getting the best outcome from rehabilitation depends on your participation in a treatment plan of adequate duration to address your individual needs. The length of time needed varies by individual. Generally, for residential or outpatient treatment, treatment lasting longer than 90 days is recommended to achieve positive, lasting results.8 How Long Does Drug Addiction Treatment usually last?
Criteria For Drug Rehab Coverage
Once someone is eligible for rehab, they need to enroll. After enrollment, however, they do not just have open access to alcohol rehab insurance or any other form of rehabilitation.
There Will Still Be Criteria That the Individual Must Meet These Criteria Are:
- Their provider states that the specific rehab services being sought are medically necessary for the patient.
- The services are rendered by an approved provider or Medicare rehab facility
- Their provider sets up the plan of care
If these criteria are met, the insured individual should access coverage for rehabilitation. Still, it is possible that the services covered will be limited. For example, insurance plans will not cover treatment in a private drug rehabilitation facility.
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Does Medicare Cover Outpatient Rehabilitation
Certain types of rehabilitation, such as physical therapy, occupational therapy and speech-language pathology, may be administered at an outpatient facility or in the home.
These types of rehab are typically covered by Medicare Part B. After you meet the Medicare Part B deductible , you are typically responsible for paying 20 percent of the Medicare-approved amount for the rehab services.
There is no limit as to how long Medicare Part B will cover these outpatient rehab services, as long as the rehab is considered medically necessary by your primary health care provider.
Medicare Coverage For Inpatient Rehab
Medicare may cover your drug rehab program!
Medicare Part A provides its standard coverage for a hospital stay for anyone who is hospitalized for substance abuse treatment. Hospital stays for drug treatment can include support for detox and withdrawal, counseling and medications.
Medicare makes one important exception to this policy, and this can affect people with a dual diagnosis a mental health condition along with addiction. The program will cover only 190 days in a dedicated psychiatric hospital over a users entire lifetime. If a patient reaches that limit, Medicare may cover more mental health treatment, but only if its provided in a general hospital or in a clinic associated with a hospital.
Medicare may also pay all or part of the costs of partial hospitalization programs, or PHPs. This kind of program combines features of both inpatient and outpatient rehab, so that users spend their days in intensive addiction therapy, but they spend evenings and weekends at home.
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What Types Of Rehab And Treatment Services Does Medicare Cover
Medicare covers a broad range of inpatient and outpatient, the exact scope of which is broken down under Parts A and B.
Medicare Part A covers inpatient treatment services. Inpatient care requires patients to stay in a residential facility while they heal from substance use disorder. These programs typically last 30-60 days.
Medicare covers a variety of inpatient services including:
- Inpatient Hospital Care
- A Semi-Private Room
- Nursing Services
Medicare will not cover a private room , phone or TV in the room or personal items, like toiletries, comfort and quality-of-life items. Medicare Part B will cover doctors service administered in an inpatient or residential facility.
Medicare Rehab 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
- 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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What Are Medicares Coverage Levels And Plans
Medicare has 3 components that cover different areas of care as follows:3
- Part A: Covers hospital insurance, including inpatient care associated with addiction treatment.
- Part B: Applies to outpatient care, including doctor visits, preventative care, and outpatient addiction treatment.
- Part D: Covers prescription drug costs, including medication-assisted treatment.
There are 2 types of Medicare coverage:3
- Original Medicare: This plan includes Medicare parts A and B. It covers partial costs for care, including addiction treatment. You can also add Part D for more coverage.
- Medicare Advantage: This plan includes parts A, B, and D in one package and allows you to combine your Medicare coverage with other Medicare-approved insurance plans.
Rehabs.com strives to provide you with the most updated information on each carriers addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.
Medicare Also Covers Outpatient Rehabs
Medicares Part B coverage can help with the costs of outpatient rehab services when those services are provided through a hospitals outpatient medical programs or a clinic that provides medical services. Typically, Medicare pays for 80 percent of the approved amount for mental health and drug rehab services provided on an outpatient basis. The remaining 20 percent can be paid out of pocket or by supplemental insurance plans.
Outpatient rehab services that are typically covered by Medicare Part B include:
- Post-hospitalization follow-ups
- Patient education on diagnosis and treatment
- Prescription drugs administered during hospitalization or at a doctors office
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How Do The Different Parts Of Medicare Contribute To Addiction Treatment
You may already know that Medicare is comprised of four different parts: Part A , Part B , Part C , and Part D . However, what you may not know is specifically what the different parts of Medicare cover when it comes to treatment for substance abuse. Lets take a look at the role of each part in this type of treatment.
How Can Medicare Help
Medicare is a federally funded healthcare support program for seniors and people with ongoing disabilities. Medicare Part A covers most costs of hospitalization, while Part B covers general medical services such as doctor visits and outpatient procedures. Many people also enroll in Part D, which helps with the costs of prescription medications. Medicare covers either all or a part of the costs of covered services, and users pay a co-pay for the difference.
Medicare will cover most if not all the costs for drug and alcohol rehab services if:
- Services are provided by a Medicare participating provider or facility such as a hospital or clinic
- A participating doctor establishes that rehab services are medically necessary
- The doctor sets up a plan of treatment
The Growing Issue Of Substance Abuse Among American Seniors
Substance abuse continues to be a growing problem among older Americans, specifically when it comes to alcohol and prescription drug addiction. According to the National Institute on Alcohol Abuse and Alcoholism by way of Addiction Center, this type of substance abuse affects up to 17 percent of adults over the age of 60.
Fortunately, there are resources available that can specifically assist seniors with substance abuse issues. Believe it or not, these resources, treatments, and forms of care are often covered by Medicare. However, before we can discuss how Medicare can potentially offer addiction treatment, we must take a deeper look at how this problem specifically affects older individuals.
Will Medicare Advantage Cover Addiction Treatment
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
- 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.
Paying For Rehab With Medicaid And Medicare
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Common Questions About Rehab
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Does Medicare Pay For Drug And Alcohol Rehab
Many programs accept Medicare as a form of payment for rehab treatment. The Substance Abuse and Mental Health Services Administration, or SAMHSA, provides a great deal of information about substance use treatment and maintains a treatment locator, which can help you find Medicare-sponsored rehab programs by searching by zip code.
Some people have Medicare Advantage programs, which are slightly different than traditional Medicare. Medicare Advantage programs may have in-network and out-of-network providers. It is best to check with your Medicare Advantage plan to see if a particular treatment program is in-network.7
Does Medicare Pay For Substance Abuse Treatment
If you are a Medicare beneficiary, you may be wondering if Medicare covers treatment for substance use disorder. Both original Medicare and Medicare Advantage plans cover various treatment options for this condition, including inpatient care, outpatient care, and prescription drugs.
In this article, well discuss Medicare coverage options for substance use disorder treatment.
If you are a Medicare beneficiary, you are covered for many of the treatment options currently available for substance use disorder. Heres how Medicare covers you for these treatments:
- Medicare Part A covers inpatient hospital care and inpatient care in a rehabilitation facility or hospital.
- Medicare Part B covers outpatient mental health services, alcohol misuse screenings, and other behavioral health services.
- Medicare Part C covers anything already included under Medicare parts A and B, plus extras like prescription drug coverage.
- Medicare Part D covers certain prescription drugs that may be necessary in the treatment of substance use disorder.
- Medigap covers certain expenses related to your original Medicare plan, such as deductibles, copayments, and coinsurance.
- coordinated care from nurses and physicians
- any drugs necessary for treatment while youre an inpatient
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Finding A Treatment Center That Accepts Medicare
The Physician Compare tool on Medicare.gov lists all treatment facilities that accept Medicare insurance in your area. Each rehabilitation facility is part of a network, updated in the federal system in real time. You may also want to contact your supplemental insurance provider to see if both policies can help cover all or the majority of your treatment and aftercare. If you have further questions about your policy, you can access help, with your caseworker, to ensure youre using every resource available to you.
How Might Substance Abuse Affect Senior Citizens
Unfortunately, due to high patient volume and a need for quick turnaround, symptoms of substance abuse in seniors often goes overlooked. Diagnosing a senior with a substance abuse disorder can also be a challenge due to the elderly populations higher rate of disorders like depression, diabetes, and dementia, which can often mask substance abuse problems.
Some symptoms of substance abuse disorders in seniors include:
- Memory issues
- Case management and community-linked services
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Other Benefits For Addiction Treatment
Many Medicare Advantage plans offer supplemental benefits you can’t get with traditional Medicare. The specific supplemental benefits you can get depend on your plan. You may have to meet certain eligibility criteria, such as getting a referral from a doctor. Some supplemental benefits that may offer additional support to people living with addiction include:
- complementary and holistic care, such as acupuncture and chiropractic care
- nutrition and wellness consultations
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Bill found John curled up on the couch he looked miserable. Bill asked, âWhat’s wrong with you?â âI’m sick, man. You got any?â was John’s weak response. As Bill suspected, John was in withdrawal. An active heroin user, John was low on cash …
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