Alcohol Addiction: Treatment And Rehab
Drinking alcohol is a common and often problematic occurrence throughout the United States, where approximately 17 million people were classified as heavy drinkers in 2020. 1 In that same year, more then 28 million people in the U.S., ages 12 and …
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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.
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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.
Aetna Insurance For Outpatient Rehab Centers
Medicare and Medicaid plans under Aetna provide coverage for outpatient drug and alcohol rehab if deemed necessary by a provider. The addiction treatment that Medicare covers may include intensive outpatient programs, which meet a few hours a week, and partial hospitalization programs, which meet 20 hours a week or more.10
As noted with inpatient addiction treatment, the amount of coverage provided for outpatient treatment through Aetna medical insurance plans varies. In one Aetna insurance plan in Maine, outpatient treatment has a coinsurance rate of 30% of overall treatment cost, whereas a plan in Illinois has a $35 per visit co-pay.7,8 A typical Federal Aetna plan offers a 20% coinsurance coverage option for outpatient treatment.9
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- Medicare will cover inpatient and outpatient alcohol treatment, but there are special rules that limit coverage
- Its common for alcohol treatment centers to accept Medicare as well as Medicaid
- Medicare Parts A and B pay for alcohol misuse treatment for inpatient/outpatient care, as well as other treatments associated with alcohol abuse
Health insurance can cover the cost of most alcohol treatment centers, Medicare included. Alcohol treatment is a vital service for your health and happiness. If you need help, the sooner you get started, the better.
If youre ready to find alcohol treatment centers that accept Medicare, you should start by looking at Medicare quotes. Enter your ZIP code into our free tool above to compare quotes available in your area.
Medicaid Coverage From Aetna Insurance
Aetna insurance therapy coverage varies by plan and includes managed Medicaid plans for people who qualify for Medicaid coverage based on income and other factors. Aetna Medicaid is offered in several states including California, Illinois, New York, and Florida.3
Medicaid covers alcohol and drug rehab, and you can link to your states program at Benefits.gov for more information.4 While Medicaid frequently covers inpatient rehab, not all treatment programs will accept Medicaid. Therefore, it is important that you check your healthcare benefits through Aetna Medicaid coverage5 and also make sure that the provider you are interested in accepts Medicaid.
When you are a recipient of Medicare, you can also get inpatient rehab with a deductible of $1,480. A deductible is a fee you are responsible for before the insurer contributes to the cost of treatment. You also must pay 20% of the costs of inpatient treatment.6 Aetna offers numerous plans that provide Medicare coverage.2
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Length Of Rehab Stay Covered By Medicaid
The length of time a person spends in rehab depends on their individual needs as well as their specific provider benefits. There is no predetermined length of treatment that applies to everyone. However, evidence indicates that treatment outcomes are contingent on adequate treatment length.10
Each state has different rules for eligibility and treatment coverage for inpatient rehab. Prior to the ACA, addiction treatment services were often not covered by private insurance and were extremely limited for people with public insurance.11 Insurance companies now have to provide a full range of treatment services, including residential treatment for substance use disorders.11
Inpatient treatment can last anywhere from 5-7 days for medical detox and up to 90 days or more depending on a persons needs and how they progress in treatment. Outpatient care can last a year or more.12
Medicare Coverage For Inpatient Rehabilitation
Medicare Part A covers medically necessary inpatient rehab care, which can help when youre recovering from serious injuries, surgery or an illness. Inpatient rehab care may be provided in of the following facilities:
- An inpatient rehabilitation facility
- Acute care rehabilitation center
- Rehabilitation hospital
For inpatient rehab care to be covered, your doctor needs to affirm the following are true for your medical condition:
1. It requires intensive rehab
2. It needs continued medical supervision
3. It needs coordinated care from your doctors and therapists working together
Medicare will cover your rehab services , a semi-private room, your meals, nursing services, medications and other hospital services and supplies received during your stay. Medicare wont cover private duty nursing, a phone or TV, personal items or a private room .
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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.
Inpatient And Outpatient Alcohol Treatment Centers That Accept Medicare
While Medicare does cover certain aspects of alcohol treatment, there are more rules than with other health care services. Compared to other conditions and treatments that Medicare covers, alcohol treatment services just arent as extensive.
However, this shouldnt stop you from seeking treatment. Medicare insurance covers a lot of crucial services, and there are other ways of paying for alcohol treatment, even if youre on a low-income budget.
Medicare covers both inpatient and outpatient services. Inpatient treatment happens when you need to be hospitalized for a period of time.
For inpatient alcohol treatment, Medicare covers:
- Detoxification
- Drugs that arent self-administered, such as IV medication
- Activity therapies
- Diagnostic exams for mental health disorders
While Medicare covers outpatient services, you will need a physicians note saying that the treatment is necessary. Youll also need your physician to create a care plan for you that includes at least 20 hours of treatment a week.
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Does Medicare Pay For Substance Abuse Treatment
Substance use disorder formerly known as substance, drug, or alcohol abuse affected roughly 20.4 million people in 2019.
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
Medicare Part B Covers Outpatient Drug Rehab Treatment
Medicare Part B helps pay for drug treatment received at a clinic or doctor’s office.
Covered rehab services typically include:
-
An assessment to determine the severity of your substance abuse
-
Psychotherapy
-
Patient education to help you better understand your diagnosis and treatment options
Typically, Medicare covers 80% of the Medicare-approved amount for a service, and you pay the remaining 20% .
In 2022, the Medicare Part B deductible is $233 per year.
Read Also: What Is The Difference Between Medicare Supplemental And Advantage Plans
Is Aarp Behavioral Health Covered By Insurance
AAPR supplemental Medicare insurance can be used to cover the costs related to behavioral health. Medicare Part B can cover outpatient behavioral health services, while Part A can cover inpatient services. There are certain deductibles for Medicare Part A, which for example was $1,288 in 2016, and there was no coinsurance obligation for members for the first 60 days.
Part B covers mental health services outside of the hospital which can include annual depression screening, psychiatric evaluation, diagnostic tests ordered by providers, and partial hospitalization. Also covered by Part B or supplemental plans include family counseling and individual and group psychotherapy by licensed professionals.
Seeking addiction treatment can feel overwhelming. We know the struggle, which is why we’re uniquely qualified to help.
Your call is confidential, and there’s no pressure to commit to treatment until you’re ready. As a voluntary facility, we’re here to help you heal — on your terms. Our sole focus is getting you back to the healthy, sober life you deserve, and we are ready and waiting to answer your questions or concerns 24/7.
How Long Will Medicare Pay For Rehab
Medicare generally covers inpatient rehab for up to 60 days of inpatient care.
The cost breakdown is as follows:
- Days 1-60: $1,364 Deductible
- Days 61-90 $341 Daily Copay
After day 90, a $682 coinsurance per each lifetime reserve day after day 90 for each benefit period . Each day after the lifetime reserve days, patients are required to pay all costs of their rehab care. The exact number of days Medicare will pay for rehab will vary, according to each patients specific plans and resources.
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List Of All Rehab Centers That Accept Medicaid And Medicare Nearby
Medicare and Medicaid are two programs designed to help Americans afford necessary medical care, including those looking to start rehabilitation in an addiction treatment center. Finding a treatment center that will accept these programs can be challenging, but knowing where to look can help start your journey on the right foot.
What Are Medicare Eligibility Requirements
Medicare is available for certain categories of people. If you are in the qualifying group, you can enroll in this government-funded health insurance. Those who are eligible for Medicare are either: 8
- 65 years and older.
- Younger than 65 with a qualifying disability.
- Those with end-stage renal disease , which is permanent kidney failure.
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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
Humana Substance Abuse Treatment Coverage
Managing the behavioral health benefits of the company, Humana Behavioral Health offers coverage for premier mental health and substance abuse services in Jeffersonville, Indiana. This specialized branch of Humana coverage offers services for clients suffering from anxiety, depression, and co-occurring drug and alcohol substance use disorders. More specifically, Humana Behavioral Health services over 5 million members nationwide. With over 350,000 medical providers in-network, Humana extends its coverage across the entire United States.
Humana HMO & In-Network plans offer coverage for rehabilitation services, including drug and alcohol rehab. However, copays and deductibles are dependent upon each individual policy as well as the state that the policyholder resides in. Pax Riverbend does accept Humana plans, but the coverage varies according to the specific plan. In other words, your plan may only offer partial coverage of your treatment and its always best to check with your Humana coverage prior to enrollment.
Humana offers coverage for several treatment services such as:
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Arc Accepts Most Medicare Insurance Policies
Americas Rehab Campuses accepts most insurance providers, including Medicare insurance policies. If you are 65 or older and want to know if you qualify to receive Medicare, visit the Medicare website to determine your eligibility and calculate your premium. If you are under the age of 65, you may be eligible for Medicare if you have received Social Security Disability Insurance checks for at least 24 months, or if you have been diagnosed with end-stage renal disease.
If you already have Medicare, Medicaid, or another insurance plan, fill out our free insurance benefits form to quickly and easily verify your plan benefits for addiction treatment. Or, call us today at 833-272-7342 to speak with one of our treatment consultants who can verify your insurance benefits for you and discuss all your available treatment options.
Recent Updates
Medicare & Medicaid Eligibility
To use Medicare for an addiction recovery program at a rehabilitation center, the individual must meet certain eligibility requirements:
- Age 65 or older.
- Younger than 65 and have a disability.
- Younger than 65 and have end stage renal disease .
If Medicare isnt a possibility, some individuals qualify for Medicaid coverage. In the state of Utah, the requirements to qualify for Medicaid coverage are as follows:
- Age 19-64
- U.S. citizen or qualified alien
- Resident of the state of Utah
- Household income up to 5% federal poverty level
- Ineligible for any other Medicaid program
- Meet one of three targeted categories:
- Group 1: Chronically homeless.
Read Also: Who Is Eligible For Medicare Extra Help
Will Medicare Cover Alcohol Rehab
As part of its substance abuse coverage, Medicare covers both inpatient and outpatient alcohol rehab if its medically necessary. You must receive treatment in a Medicare-approved treatment facility.
Inpatient treatment usually lasts from one to three months, and it may occur in either a hospital or a rehab center. If you get inpatient treatment, youll pay Part A costs.
If you have inpatient treatment at a specialty psychiatric hospital, you should know that Medicare will only pay for 190 days of treatment at a psychiatric hospital in your lifetime.
Outpatient rehab falls under Part B. Also, partial hospitalization is where you report to a hospital or mental health center for intensive treatment, but dont stay overnight. Part B covers the necessary partial hospitalization.
If Medicare is your only insurance, alcohol treatment can be costly. But a Medigap plan can pay the Part A deductible and extend the number of days Medicare pays for hospitalization.
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
- 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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