Does Medicare Cover Drug Rehab?

Substance, drug, or alcohol abuse now falls under the “substance use disorder” label, and it affects millions of people. If you have Medicare benefits, you may wonder if it helps pay for drug rehab and general treatment for substance use disorder. The good news is, both Medicare Advantage plans and Original Medicare have coverage for several treatment options, including outpatient care, inpatient care, and prescription drugs. 

Substance use disorder and Medicare benefits

If you have Medicare, you have coverage for several different treatment options. Medicare will cover the cost for these treatments in the following ways:  

• Part A – Under Original Medicare, Part A covers inpatient care in a hospital or rehab facility as long as you’re an inpatient. 
• Part B – This section of Original Medicare pays for a portion of your alcohol misuse screenings, outpatient mental health services, and several other types of behavioral health services. 
• Part C – Part C will cover anything that Original Medicare will pay, and it also may offer extra coverage for things like prescriptions. 
• Part D – Part D pays for some prescriptions drugs that you may need during your treatment for substance abuse disorder. 

Medigap – This insurance will pay for some expenses related to having Original Medicare coverage, including coinsurance, copayments, and Part A deductibles. 

Medicare Coverage for Inpatient Treatment

Under Original Medicare, Part A is your hospital insurance. It will help pay for any inpatient hospitalization you may have due to treatment for drug rehab in a rehabilitation hospital or in a rehabilitation facility. This coverage will include: 

• Any drugs you need for your treatment while you’re admitted as an inpatient
• Coordinated care from doctors and nurses
• Inpatient drug rehab services
• Inpatient hospitalization

Inpatient treatment costs

• Coinsurance – If you’re there more than 60 days, you’ll have to pay $372 every day for days 61 to 90. From day 91 up to 60 days over your lifetime reserve, you’ll pay $742 a day. 
• Deductible – In 2021, your deductible for Part A is $1,484.

Medicare benefits for outpatient treatment

Part B is medical insurance, and it helps to cover the costs of outpatient alcohol misuse screenings, mental health counseling, and an intensive outpatient program for your drug rehab.

The coverage includes: 

• Alcohol misuse screenings
• Certain prescriptions 
• Individual or group therapy sessions
• Outpatient hospital services
• Partial hospitalization
• Psychiatric evaluations

Medicare may also help cover the cost of screening, brief intervention, and referral to treatment (SBIRT). These services are aimed at people who are at a higher risk for developing a substance use disorder. 

Outpatient treatment costs

• Coinsurance – This amount is typically 20% of the Medicare-approved amount for services once you meet your deductible. 
• Part B Deductible – $203 per year in 2021. 
• Premium – The standard premium is typically $148.50 a month. It can be higher, depending on your income level. 

Prescription drug coverage

Part D is an add-on to Original Medicare, and it helps you pay for your prescription drug costs. You can use it to help pay for the prescriptions you get during treatment, including: 

• Acamprosate
• Buprenorphine
• Bupropion
• Chantix (varenicline)
• Disulfiram
• Methadone
• Naltrexone
• Nicotine replacement therapies

It’s important to note that every drug plan for prescriptions has a specific list of approved drugs. The drugs get arranged in tiers, from generic drugs to the more expensive brand-name ones. So, the cost will vary, depending on which tier it falls in.

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