There is frequently some question about what Medicare does and does not cover. One of the most frequently asked questions is whether substance abuse treatment services, such as inpatient or outpatient rehab, is covered under Medicare.
The short answer is yes, although with some stipulations. Treatment for substance abuse and other addictions are covered under Medicare’s coverage of mental health care, and the reimbursement falls under the mental health care benefit schedule.
Medicare will help cover inpatient and outpatient treatment for drug and alcohol addiction if each of the following three criteria is met:
- You receive your medical services from a Medicare-approved provider or facility
- That doctor deems the services to be medically necessary
- That doctor puts together a treatment plan for you to follow
How much of the treatment it covers may vary. Medical Part A can cover any inpatient drug and alcohol treatment, such as hospital meals, nursing, the room, and other applicable services. Your out-of-pocket costs will be the same as they would be for any other hospital stay.
If this treatment is to be received in a psychiatric hospital, be aware that Medicare will only cover 190 days of psychiatric hospital treatment in an entire lifetime. If a person reaches their lifetime limit, their mental health care treatment can still be covered if they receive it in a general hospital. This is only applicable to standalone psychiatric hospitals. There is on limit on treatments days in psychiatric wards of general hospitals.
Medical Part B covers outpatient therapies, lab tests, and some specific services provided by inpatient or outpatient substance abuse professionals. It will cover the cost of diagnosis by a Medicare-participating professional, the establishment of a treatment plan, and any necessary physician follow-up care. Outpatient prescription drugs can only be covered under a Part D plan through a formula or exception process.
The way the Medicare program works, it does not cover a defined amount of services. Instead, it will cover a portion of the total health care cost. Currently that portion is set at 65 percent of the approved amount for mental health care services. That may include services for drug and alcohol addiction treatment, as long as the services are deemed reasonable and concur with Medicare’s standard of what is medically necessary. You or your supplemental insurance provider will be required to pay the final 35 percent.
If you or someone you know needs help with addiction or finding an alcohol detox, we can help: Call Today (800) 305-3417