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Medicare Coverage for Addiction Rehab: Navigating the Benefits

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Being admitted to an addiction treatment center or rehab center can be costly. With multiple programs for different types of addiction, we often consider the journey towards recovery a financial investment. Most of the time, Americans with average salaries do not have the funds necessary for comprehensive and evidence-based treatment from private health providers. In addition, suffering from drug addiction or alcoholism entails the potential loss of a job or even homelessness, which may contribute to extra financial constraints. 

However, many existing insurance programs aid in the costs of medical procedures of individuals. These health insurances cover not just surgeries and physical therapies but also mental health treatments and psychosocial services, which include substance addiction treatment. Medicare is a national health insurance program in the United States, offering various sets of benefits for registered individuals. Medicare is considered one of the most favored insurance providers, as it has served around 59.9 million individuals in recent years.

Being aware of the insurance coverage of various programs, particularly Medicare, allows people to make informed decisions and gives them the capacity to plan the steps they will take in approaching addiction recovery.

General Provisions of Medicare

Medicare is a health insurance program provided by the US federal government. The general benefits of Medicare can be availed through a manual application or simple procedural steps when one is already registered under the Social Security Administration. The health insurance program was designed for the following categories of people:

  • Individuals 65 years or older
  • Young or old individuals with disabilities 
  • People with end-stage organ diseases

What qualifies as a disability or disease is determined by the program’s administration, the Centers for Medicare and Medicaid Services. They ensure that appropriate benefits are given to eligible individuals. As drug and alcohol addiction is considered a disease, Medicare’s benefits can also be accessed for addiction treatment. However, specific conditions must be met for the coverage to be valid:

  • The provider must state that the services are medically necessary.
  • The treatment and care must be received from Medicare-approved facilities and providers.
  • There must be a specific, measurable, and time-based plan of care presented by the provider.

These provisions are established to ensure the validity of the financial aid request, as substance addiction treatment programs vary depending on the unique situations of individuals. This is also a way to make providers design programs, which are cost-efficient and effective to avoid wasting insurance benefits. As the government manages Medicare, its goal is to provide insurance to as many individuals as possible, considering that health and lifestyle are significant aspects of a person’s life.

Three Parts of Medicare

The categories of Medicare benefits are broken into three parts, which cover specific services:

Medicare Part A (Hospital Insurance). Part A includes financial help for inpatient treatment. It covers hospital admissions and residential recovery in drug rehab centers. Benefits of Part A also include hospital stays, care in a skilled nursing facility, hospice care, and home-based health care. Using the provisions of Part A, inpatient care for substance abuse disorder can be covered if the healthcare provider deems the services necessary and reasonable.

Medicare Part B (Medical Insurance). Part B includes financial help for outpatient treatment services. It covers services through drug rehabs, clinics, or hospital outpatient centers. Part B also includes doctors’ services, outpatient care, medical supplies, and preventive methods. Medicare Part B provisions cover partial hospitalization and outpatient treatment, which have severity assessments and behavioral therapies for substance addiction rehab.

Medicare Part D (Drug Coverage). Part D includes financial help for necessary prescription drugs or medications for diseases, including addiction. Although not all drugs are included in the Medicare program, it covers antidepressant, anticonvulsant, and antipsychotic medications, which may come up during mental health recovery. Part D also includes painkillers, shots, and recommended vaccines. Using Part D coverage includes medications used in substance addiction treatment, such as Suboxone, which is used for opioid use disorder. This holds, as long as the medication is specified in the detailed plan crafted by the provider.

In addition to these three general parts, Medicare can also cover specific types of interventions. For example, SBIRT, Alcohol Risk Screening, and general counseling are included, as they are deemed supplementary to drug addiction treatment. It is essential to inquire about other specifications of the Medicare coverages to get the most out of the insurance program.

Medicare Copay for Inpatient Rehab and Outpatient Services

Inpatient drug rehabilitation is under hospital insurance (Part A) of Medicare. This means that individuals admitted for short-term or even long-term addiction treatments will receive cash assistance from Medicare. As the time of inpatient stay varies per individual, the amount of financial aid also changes after 100 days. According to the official site of Medicare, the payment of individuals for each benefit period is as follows:

  • Days 1–60: $0 daily coinsurance, but has a $1,364 deductible in case of inpatient rehabilitation facility transfers.
  • Days 61-90: $341 coinsurance each day.
  • Days 91 and beyond: $682 coinsurance for each “lifetime reserve day” after day 90. However, the patient covers all costs for each day after the lifetime reserve days.

Although there is a certain limit to the number of sponsored days, each benefit period ensures that there is still aid given to the individual going through the short term or long-term rehab treatment. This has also been the established provision of Medicare as most addiction treatments conclude in 60 days, but with an emphasis on post-treatment care. As post-treatment requires a few returns to the rehab center, behavioral therapies and counseling regarding sobriety are also covered by Medicare. To be specific, the following are mental health services covered by Medicare’s Part B:

  • Individual and group psychotherapy with licensed professionals
  • Peer support sessions
  • Family counseling
  • Psychiatric evaluation
  • Medication management
  • Therapies and interviews for drug and alcohol detox programs

These show that general health insurance programs, such as Medicare, allow people to access recovery treatment and treatment for mental health. Regardless of financial situation, almost everyone has the right to access evidence-based and comprehensive treatment. In addition to health insurance, there are even existing helping hands, like free alcohol rehabs. Learning how to navigate through Medicare, and knowing where to look for affordable recovery options, such as addiction treatment in Simi Valley, is a significant step. 

Limited financial resources are a growing concern in the country. Knowing the regulations of health insurance programs might already mean you are a few inches closer to a better life for you or your loved ones in the years to come.

Restore Health and Wellness Center can help you navigate your current medical insurance. Let us discuss how we can afford you an appropriate treatment program. Our staff members will be committed to understanding your situation and giving you more information on getting started. 

If you’d like to know more, give us a call at (818) 405-8656 or visit our drug rehab center in Simi Valley, CA at 6918 Owensmouth Ave Canoga Park, CA 91303.

  • 24/7 Admissions (818) 722-9019 
  • On-Site Contact (818) 806-3914


Disclaimer: This post serves a strictly educational use. It does not necessarily reflect the services, products, or therapeutic approaches of this establishment or its healthcare practitioners. This blog aims not to advertise the products, services, or therapeutic approaches of any other establishment that may be associated with this site. On the subject of safe or legal services, products, and appropriate therapies, recommendations ought to be given by a qualified professional on a case to case basis. 


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