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Will Medicare Pay For Drug Rehab

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Aetna Insurance For Inpatient Rehab Centers

How to Pay for Rehab

Some Aetna plans also cover inpatient rehab. For example, one Aetna plan in Maine for government employees has a $400 individual deductible and an $800 family deductible. After meeting your deductible, this Aetna plan covers the costs of inpatient treatment except for a 10% co-insurance payment. This means you will be responsible for 10% of the overall cost of inpatient treatment.7

One Federal Aetna plan lists 20% co-insurance rates for some plans for inpatient rehab with a $700 individual deductible and a $1,400 family deductible.9 Another Aetna insurance plan, for the employees of the State of Illinois, offers a no-deductible plan with a $375 co-pay for inpatient drug and alcohol rehab.8 These examples show that the coverage varies a great deal from one Aetna plan to another, but all Aetna insurance plans cover some part of inpatient rehab.

Understanding Alcohol And Drug Treatment Facilities That Accept Medicare

There are several types of Medicare – including Parts A through to D. Some of these types will cover particular drug and alcohol abuse treatment services. For instance, Medicare Part A covers stays at inpatient hospitals – which you may find necessary, especially if your drug and alcohol addiction requires detoxification and other treatments only found in inpatient hospital settings.

Hence, if you have been using prescription drugs and need help to conquer your dependency to them, this portion of Medicare may prove useful for you. By ensuring that you enroll into alcohol and drug rehab programs that accept Medicare, you will be able to receive inpatient drug and alcohol addiction rehab.

Medicare Part An also pays for treatments that could prove essential in helping you overcome co-occurring issues – particularly if you struggle with a combination of mental health and substance abuse problems. Hence, in case you get hospitalized and get the inpatient services that Medicare pays for, your out of pocket costs will be the same as if you had resided in hospital for another purpose.

On the other hand, Medicare Part B tends to pay for outpatient treatment. These are also offered by drug and alcohol treatment programs that accept Medicare – particularly in addiction rehab programs, in addition to hospital and clinic outpatient departments.

If Youre Having Surgery Check Medicares 2020 Inpatient Only List

Some surgical procedures always require admission as an inpatient. The 3-day rule does not apply for these procedures, and Medicare will cover your inpatient rehabilitation after the surgery. These procedures can be found on Medicares inpatient only list.

In 2018, Medicare removed total knee replacements from the inpatient only list. In 2020, Medicare also removed total hip replacements from the list. The 3-day rule now applies to both of those procedures.

If you have a Medicare Advantage plan, talk with your insurance provider to find out if your surgery is considered an inpatient-only procedure. Each plans coverage rules differ, and knowing whether the 3-day rule applies could save you a lot of money.


If you have a Medicare Advantage plan, your costs may be higher or lower based on whether your healthcare providers and rehab facility are in network or out of network. Check with your plan before being admitted to a facility to make sure that its in network. This will help ensure full coverage and maximum cost savings.

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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

Medicaid For Drug And Alcohol Rehab

Medicare Coverage for Drug Treatment Centers

Medicaid is a public insurance program for low-income families. Under the 2010 Affordable Care Act , also known as Obamacare, insurance providers must cover all basic aspects of drug and alcohol dependency recovery. While Medicaid covers substance abuse treatment, not all facilities accept Medicaid as a form of payment. To find a recovery provider that accepts Medicaid, get in touch with the Substance Abuse and Mental Health Services Administration .

Featured Centers Accepting Medicare And/Or Medicaid

Addiction Center is not affiliated with any insurance.

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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.

What Types Of Rehab Treatment Does Medicare Cover

With most Medicaid plans covering at least some of the costs of rehab treatment for alcohol addiction or drug addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:4,5

  • Detox services: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, painful, or even life threatening. Medical detox helps you safely withdrawal from drugs and alcohol, as youll receive around-the-clock medical supervision. You might also be given medications to help minimize withdrawal symptoms.
  • Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 1590 days, depending on the program youre in and your individual needs.
  • Partial hospitalization : Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.
  • Intensive outpatient program : Intensive outpatient programs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and even go to work during the day.
  • Outpatient treatment: Individuals who have completed inpatient treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 1012 hours a week at the treatment facility for therapy and support.

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Medicare Coverage And Overdoses

In the event that you or someone you love suffers an overdose, Medicare covers some treatments. For example, most Medicare Part D plans cover Narcan, the drug used to reverse the effects of an opioid overdose.

Typical co-pays for most people with Part D and certain Part C plans for Narcan range from $19-$144.

Medicare Part A is hospital insurance, and it will cover your hospital stay, but not all services fall under Part A. Ambulance transportation is under Part B, and so is doctor observation until you are officially admitted into the hospital.

The Centers for Medicare & Medicaid Services cover mental health treatment. Medicaid is a federal and state program to help you with your medical costs if you have limited income.

Mental health treatment services are based on screening, brief intervention, and referral to treatment . This is an evidence-based approach used in public health for early interventions and treatment services.

Its designed to help someone at risk for a substance abuse disorder or who already has a substance abuse disorder.

For instance, after this comprehensive evaluation protocol, someone addicted to heroin might be administered methadone to reduce the intensity of withdrawal symptoms. If this patient does not benefit from outpatient treatment, then inpatient psychiatric care is another option. Such residential treatments provide a space for treatment, sleeping, bathing, recreation, and dining.

Dont Let Insurance Coverage Get In The Way Of Addiction Treatment

Will Medicare and Medigap Pay For My Cancer Treatment?

Drug addiction and alcohol addiction are diseases. If you or a loved one is suffering from one of these diseases, you should be able to seek addiction treatment without fear that your insurance program will not be accepted. Brightview is happy to offer our addiction treatment services to those who use Medicaid and Medicare, along with a variety of other health insurance plans.

Our treatment providers dont care what kind of insurance you have. We just want to see you get well and get back to enjoying the life that you deserve.

If you or a loved one need help, please CALL US NOW 1-833-510-HELP. We have caring team members who answer the phone 24 hours a day. Give us a call and we can discuss the substance abuse services that we offer, along with how you can use Medicaid and Medicare or other health plans to get the substance abuse treatment that you deserve.

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Addiction Treatment For Seniors And Medicare Eligibles

Treatment for addiction is a lot like treatment for any other disease. It starts small, often with preventive measures, and will progress according to the doctors recommendations.

Medicare pays for alcohol and substance abuse treatment for both inpatients and outpatients. Substance use disorders are drug addictions that influence a persons thoughts, feelings, and behaviors.

These disorders arent just limited to illicit drugs, such as Cocaine, Ecstasy, GHB, Hallucinogens, and Heroin, among others. They can also include misuse of legal drugs like nicotine, marijuana, or alcohol as well as legal medications like fentanyl , hydrocodone , or oxycodone .

The American Society of Addiction Medicine divides treatment into five levels of care. Heres how they relate to Medicare:

Level 0.5, Early Intervention Education and prevention for people who are at risk of developing an addiction fall under this level. Medicare can cover a conversation with your doctor about a prescription drug that may be habit-forming.

Level 1, Outpatient Treatment This level of addiction treatment refers to nine hours or less of weekly counseling services or recovery. Outpatient mental health services fall under Medicare Part B and certain Medicare Advantage plans.

Level 2, Intensive Outpatient and Partial Hospitalization

A doctor must say that PHP is medically necessary, and your treatment plan must include at least 20 hours of treatment per week.

PHP services can include:

Level 3, Inpatient Treatment

Medicare Coverage For Rehab Services

Because skilled nursing is an inpatient service, most of your Medicare coverage comes through the Part A inpatient benefit. This coverage is automatically provided for eligible seniors, usually without a monthly premium. If you get Medicare benefits through a Medicare Advantage plan, your Part A benefits are included in your policy.

Though most people pay no monthly premium for their Part A benefits, you may have to pay the standard inpatient deductible before getting care. In 2021, this amounts to $1,484 that has to be paid before your Medicare benefits kick in for any inpatient care you get. Fortunately, Medicare treats your initial hospitalization as part of the same inpatient care experience as the rehab services you get later, so your initial deductible payment counts toward your inpatient charges in rehab.

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Paying For Rehab Without Insurance

You have options to help you pay for substance abuse rehab. Several states offer programs and grants to assist people without insurance. According to the National Survey of Substance Abuse Treatment Services,5

  • 7,238 substance abuse facilities received federal, state, local, or county funds for the program,
  • 6,036 facilities didnt charge any fee for clients who couldnt afford it, and
  • 8,024 facilities offered a sliding fee scale.

While rehab can seem overwhelming and expensive, there are many ways you can afford treatment. Dont let the cost of rehab stop you from seeking treatment to start on your path toward recovery.

Does Medicare Cover Opioid Treatment

Does Medicare cover substance abuse treatment? Rules and ...

In 2020, the Medicare program includes paying for Opioid Treatment Programs . The Medicare-enrolled opioid treatment program is comprehensive, consisting of periodic assessments, intake procedures, toxicology testing, individual therapy, group therapy, and counseling for substance use.

It also includes FDA approved opioid treatments and medication-assisted treatment medications as well as the dispensation and management of MAT medications. A search for opioid treatment programs near me will show you a map of addiction treatment centers in your neighborhood.

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What Are You Struggling With

There are many different forms of addiction. Get the information you need to help you overcome yours. . Your Medicare coverage choices. Retrieved on December 17, 2019 from

SAMHSA. . Medicaid Handbook: Interface with Behavioral Health Services. Retrieved on December 17, 2019 from

Featured Treatment Centers

Prevalence Of Substance Abuse In Older Adults

Older adults most commonly abuse alcohol, but many also abuse prescription and illegal drugs. The percentage of older adults who met the criteria for having an addiction problem was 11.7 percent.

Drug abuse in adults older than 65 years is mainly limited to alcohol despite the prevalence of so many illicit drugs and mood-altering prescription drugs.

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Why Did Medicare Deny Alcohol Rehab Or Treatment

Medicare may deny your claim if your treatment isnt necessary or if you go to a doctor that doesnt accept Medicare. If you have a Medigap plan, those plans sometimes deny claims based on pre-existing conditions. If you were diagnosed with a substance abuse disorder before enrolling, your plan may exclude coverage.

Always read the fine print on pre-existing conditions before signing up for insurance. Finally, some Advantage plans can deny claims if your doctor isnt in your plans network.

Financing And Private Funding

Does Insurance Cover Alcohol and Drug Rehab?

If you are unable to use health insurance for addiction rehab or have additional costs that need to be covered, you can opt to finance part or all of these costs by securing a loan. You may be able to obtain a private loan from family or friends or go a more traditional route. Additionally, some people find success using platforms such as GoFundMe.

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Find A Drug And Alcohol Abuse Rehab Center In Minnesota

Developing an addiction to drugs and alcohol can have detrimental effects on a person’s physical and mental health, relationships, and overall well-being. Minnesota has a population of roughly 5.5 million and is made up of 87 counties. 1 Addiction …

Medicarefor MedicareDrugRehab

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

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Does Medicare Cover Inpatient Rehabilitation

Medicare Part A covers your inpatient care in a rehabilitation facility as long as your doctor deems it medically necessary. In addition, you must receive care in a facility thats Medicare-approved.

Depending on where you receive your inpatient rehab therapy, you may need to have a qualifying 3-day hospital stay before your rehab admission. Well discuss that rule in more detail later.

How Long Does Medicare Pay For Rehab

Medicare: Questions About Rehab

Medicare Part A covers 100 days in a skilled nursing facility with some coinsurance costs. After day 100 of an inpatient SNF stay, you are responsible for all costs.

Medicare Part A will also cover 90 days of inpatient hospital rehab with some coinsurance costs after you meet your Part A deductible. Beginning on day 91, you will begin to tap into your lifetime reserve days.”

You may have to undergo some rehab in a hospital after a surgery, injury, stroke or other medical event. The rehab may take place in a designated section of a hospital or in a stand-alone rehabilitation facility.

Medicare Part A provides coverage for inpatient care at a hospital, which may include both the initial treatment and any ensuing rehab you receive while still admitted as an inpatient.

When you have been out of the hospital for 60 days in a row, your benefit period ends and your Part A deductible will reset the next time you are admitted.

Your rehab could potentially take place in a skilled nursing facility . When you enter a skilled nursing facility, your stay will typically be covered in full for the first 20 days of each benefit period .

Days 21 to 100 of your stay will require a coinsurance payment of $185.50 per day in 2021, and you will then be responsible for all costs beginning on day 101.

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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

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