Medicare and Medicaid for Drug Rehab: What Does it Cover?

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Anyone struggling to overcome their drug and alcohol addiction can seek help from a rehab center. These facilities offer rehabilitation and a healing environment to help patients overcome addiction. Rehab centers also provide the necessary tools for a happy, healthy, and productive life. However, addiction treatment can be expensive for someone who doesn’t have health insurance coverage. Many people looking for drug rehab are unemployed or don’t have insurance through their job. Luckily, there are many treatment centers that accept Medicare or Medicaid for addiction treatment. In fact, using Medicare or Medicaid for drug rehab is one of the most often used ways of paying for the expenses. 

Avenues Recovery discusses how to determine your eligibility, how to ascertain if a facility near you accepts Medicaid or Medicare, and how to find out about the length of time you will be covered for addiction treatment under one of those plans.

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What is Medicaid for Addiction Treatment?

Medicaid is a health and medical service program for low-income households. They service people with disabilities, children, and adults. Medicaid receives funding from the federal government yet mainly from the state government. Medicaid is extremely helpful to individuals who receive low wages as it enables them to receive the proper care they otherwise can not afford. Furthermore, Medicaid plays a large role in covering drug and alcohol addiction treatment ever since the 2010 Affordable Care Act (also known as Obamacare). In fact, in 2020, Medicaid was the largest payer in the US for behavioral health services, which include substance use disorders. 

Although the federal government oversees the Medicaid program, each state has to follow various protocols. These are:

  • Creating eligibility standards
  • Setting the rate of payment
  • Deciding service duration, amount, type, and scope
  • Program administration

Therefore, the Medicaid program qualifications and services vary from state to state.

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Eligibility for Medicaid

One must meet certain criteria to qualify for the Medicaid drug rehab program. Below are some rules of eligibility patients should know before applying to Medicaid for addiction treatment:

  • Financial situation: The patient should meet the financial requirement to qualify for Medicaid. Your Modified Adjusted Gross Income will help you identify whether you will qualify for Medicaid or not. 
  • Medical situation: If one’s financial situation does not fit the criteria, he may still qualify if he/she has specific disabilities.
  • Age and role: One may also be eligible if he or she is above the age of 65, below the age of 19, a parent, or pregnant. 
  • Residency and citizenship: Patients applying for Medicaid for drug treatment should be state residents. Furthermore, they should be a US citizen or a qualified non-citizen.

Does Medicaid Pay for Drug Rehab?

Many patients want to know whether their Medicaid coverage covers drug rehabilitation services. The simple answer is yes. But, they should check their state’s policy before applying. Keep in mind that different rehab centers have different policies.

What Does Medicaid for Drug Rehab Cover?

Patients can apply for Medicaid coverage for drug and alcohol treatment. But, the amount depends on their coverage qualification. Medicaid drug rehab and alcohol treatment plans include prescription drugs, screenings, inpatient care, outpatient services, detox, family counseling, and other services. In most states, people eligible for Medicaid addiction treatment do not have to pay co-payments. In the event that they are charged, there is a maximum amount that they can be legally charged for out-of-pocket payments.

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How Many Months of Coverage Is There for Medicaid Addiction Treatment?

The duration of Medicaid coverage depends on many factors including the condition and treatments of the patients. Furthermore, it also depends on the treatment provider and their benefits. Medicaid doesn’t specify treatment length for every drug abuse patient and instead relies mostly on the treatment process.

As noted above, each state has different treatment policies and eligibility for drug abuse patients. Therefore, patients should ask their treatment provider before applying. Today, insurance companies have to cover complete treatment expenses and services for substance use disorder. This includes residential, inpatient, and even outpatient treatments. However, outpatient has lower recovery potential, so many rehab centers don’t cover this treatment process.

What is Medicare?

The federal government offers a health insurance program called Medicare that covers medical expenses for people above 65 years. This insurance policy also covers expenses for younger people with certain disabilities or kidney failure. With a Medicare insurance plan, individuals are charged a monthly premium that is based on their income level.

Eligibility for Medicare

Medicare automatically enrolls many people when they reach the age of 65. Patients who don’t get automatically enrolled can apply for coverage. For registration, you can visit the official Medicare website and follow the requirements.

The eligibility of Medicare for drug abuse includes:

  • The patient should financially qualify for the rehab treatment. If they find Medicare expensive, they can move to Medicaid, which is more suitable for low-income households.
  • The patient should be 65 or older
  • Since Medicare is managed by the Federal government, patients should be U.S. citizens or have a permanent legal residence permit.
  • A patient with a permanent legal residence permit who has lived in the United States for five years paid Medicare taxes or has 10 years of work experience.

Does Medicare Pay for Rehab?

Medicare does cover drug rehab to a certain extent. Once you register with Medicare, you can become eligible for the drug and alcohol abuse program. Medicare covers special needs plans as well. People with related conditions such as chronic mental health issues can seek financial support from Medicare. Nevertheless, Medicare does not cover all addiction treatment, and not all drug rehabs accept Medicare. Knowing the extent of Medicare addiction rehab coverage will help you make an informed decision regarding which health insurance plan you want to choose.

What Does Medicare Cover for Drug Rehab?

Medicare pays for parts of drug rehab. An Original Medicare plan has two parts: Part A and Part B, which provide health insurance for various aspects of addiction treatment. The parts of Medicare are explained below to portray what does Medicare pay for in drug rehab.

  • Medicare Part A provides health insurance for hospital stays. It includes a wide range of rehab services in a residential treatment facility. Patients can claim their Medicare coverage after they qualify for hospital stays. Medicare Part A also covers rehabilitation services in a skilled nursing facility. Keep in mind that the Medicare insurance policy covers short-term treatments only. Short-term care means that the treatment process is fewer than 100 days.
  • Medicare Part B provides medical insurance. This includes therapy, drugs from medical professionals, outpatient care, and help for co-occurring disorders. This part of Medicare pays for up to 80% of costs, yet one may still need to pay out of pocket. 

Although Medicare does cover addiction treatment partly, the Original Medicare addiction rehab coverage doesn’t include all medical costs. Instead, opting for a Medicare Advantage plan includes prescription drugs for treatment in addition to Part A and B. Another option is a Medicare supplement policy which covers more than an original Medicare plan. 

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Medicare and Medicaid Drug Rehab: Inpatient and Outpatient Coverage

Inpatient and outpatient rehab programs include 12 treatment steps that Narcotics and Alcoholics Anonymous use. Both treatment procedures include one-on-one counseling, group therapy, medical care, drug and alcohol education, and family therapy.

Patients have to consult a doctor to determine an effective treatment process between inpatient and outpatient.

Doctors will analyze your condition and recommend treatment based on various factors. These factors are:

  • Mental health
  • The severity of substance abuse
  • Family support
  • Income level
  • Lifestyle


Does Medicaid or Medicare Cover Inpatient Drug Rehab?

In inpatient drug and alcohol rehab, patients have to stay in the hospital facility throughout their treatment. Both Medicare and Medicaid cover inpatient drug and alcohol abuse treatment programs. During their stay, patients will get room and meals.

The insurance plan for drug rehab only covers benefit periods. The benefit period starts when the hospital enrolls patients for inpatient treatment. It ends when the patient leaves the facility for 60 days of care outside the hospital. During the treatment program, a patient stays inside and outside the hospital multiple times.

Under the Medicare rehab program, you don’t have to pay deductible amounts every time you stay in the hospital. A deductible is an amount that you pay whenever your coverage begins.

When you receive drug abuse treatment at a general hospital, there is no limit to the number of benefit periods. However, when you visit a psychiatric hospital, the insurance plan only covers 190 days of inpatient treatment for a lifetime.

Does Medicaid or Medicare Cover Outpatient Drug Rehab?

With both Medicare and Medicaid, you receive health care through an outpatient treatment program. This also includes hospital, lab tests, medication-assisted treatment, and psychologist expenses in some cases. The deductible varies depending on the treatment process your doctor recommends.

Medication Coverage

Rehab treatment coverage also includes prescription drugs that patients require for health condition treatments including anti-seizure medications and Methadone. In fact, Medicaid coverage for medication-assisted treatment for opioid use disorders increased in 2020. 

Do All Drug Rehabs Accept Medicare or Medicaid?

Some providers don’t accept Medicare and Medicaid for drug rehabilitation treatment. Therefore, you should confirm with the drug rehab center about their policies. Choosing a drug rehab that doesn’t accept Medicare can be expensive, so you won’t want to enroll without being absolutely sure. To find a recovery provider that accepts Medicare or Medicaid for drug rehab, reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA)

Medicare and Medicaid Drug Rehab at Avenues Recovery

Medicare and Medicaid are fantastic options for those looking for substance abuse treatment who don’t have insurance coverage or the financial ability to pay out of pocket. Knowing drug rehabs that accept Medicare or Medicaid, how long you may be covered, and which Medicare or Medicaid plans you are eligible for, will help you make the best decision to find your way back home.
There are other options to help with funding rehab treatment too- for example, rehab scholarships and grants. At Avenues Recovery, we offer a variety of treatment programs and resources geared to help you recover from addiction. If you or a loved one are interested in knowing more about how Medicaid and Medicare can pay for drug rehab, reach out to us and our professionals will be there to guide you. We will explain to you what Medicare covers in drug rehab as well as how Medicaid can help in addiction treatment. Start your journey to recovery toda

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