Does Medicare Cover Alcohol Rehab?
Medicare is a type of federal health insurance offered to people aged 65 and up and younger individuals with specific illnesses. While not as extensive as other insurance, Medicare coverage does include multiple treatment services for mental health, behavioral health, and substance abuse. Here’s what you need to know if you’re wondering whether it will cover your alcohol rehab.
Are you or a loved one facing alcohol addiction? The caring staff at Zinnia Healing can help. Contact us today at our helpline by calling (855) 430-9439. Our alcohol hotline is available 24 hours per day to provide support and assistance.”
Options for Alcohol Abuse Treatment
According to the National Institute on Alcohol Abuse and Alcoholism, alcohol addiction is a type of substance use disorder (SUD). There are multiple treatment options for SUD, including alcohol rehab, and treatment choices should depend on the individual.
If you’re pursuing alcohol addiction treatment, you should consider all of the following:
- Inpatient care at a hospital: typically offered for 10-14 days for high-risk individuals as they detox
- Inpatient treatment at a residential facility: often called alcohol rehab and can last from a few weeks to several months
- Intensive outpatient treatment: involves multiple weekly appointments and routine testing
- Outpatient treatment: personal support system helps with recovery as the patient attends mental health services as needed
As you can see, alcohol rehab is not necessarily the only option for alcohol addiction treatment, although it is one of the most common.
Everyone’s path to recovery looks different — some people will go through a hospitalization program before transitioning to a residential facility, and many will go to an outpatient program when transitioning from an inpatient facility.
No matter what treatment best fits your needs, it’s essential to know whether or not a health insurance program like Medicare will cover the cost.
What Treatment Programs Does Medicare Cover?
Medicare covers specific substance use treatment in both inpatient and outpatient settings. Like other health services, inpatient treatment is covered under Medicare Part A; the co-pays are the same for other forms of hospitalization.
Meanwhile, Medicare Part B covers outpatient services provided by a clinic or a hospital’s outpatient department.
Note that Medicare does not specify alcohol addiction treatment as a covered service because treatment is not a service in itself. Rather, your alcohol addiction treatment plan will consist of multiple services, such as inpatient prescription drugs (i.e., Methadone) to help reduce withdrawal symptoms and mental health services like psychotherapy.
For more information about Medicare coverage and limitations, see below.
1. Hospitalization
The Medicare program covers inpatient treatment in a general hospital for up to 90 days per benefit period. If you need to stay longer, you are entitled to up to 60 lifetime reserve days. This means your total stay can be 150 days (assuming you have not used any of your lifetime reserve days previously), but those lifetime reserve days will never replenish.
Medicare will cover up to 90 days per benefit period if you require hospitalization in a specialized psychiatric hospital. However, Medicare limits the total number of days a beneficiary can spend in this setting. According to Medicare.gov, the lifetime limit is 190 days as of 2023.
As you can imagine, treatment can easily exceed this limitation. Therefore, if you need additional hospitalization beyond that point, you must go to a general hospital that offers psychiatric services.
2. Partial Hospitalization
Medicare.gov notes that partial hospitalization is a type of treatment where you can receive intensive psychiatric treatment without being admitted as a patient. These programs often require you to attend multiple weekly appointments in a hospital’s outpatient department or community mental health center.
Medicare does not cover the associated transportation and meals from your time in a partial hospitalization program, but it does cover the associated services.
Those services may include diagnostics, individual therapy, group therapy, family counseling, and patient education, among other things. You may also see an occupational therapist, psychiatric nurse, or social worker during the program; these services are covered.
To ensure you receive coverage for a partial hospitalization program, you must demonstrate that your treatment is under a physician’s direct and personal supervision. As noted in Medicare Intermediary Manual § 3112.4, the provided services should be clearly outlined in your care and treatment plan.
3. Outpatient Services
According to Psychiatric Services medical journal, traditional outpatient care for substance use disorder often involves many of the same services as partial hospitalization — but to a lesser degree.
For instance, you may only receive services a few times a week instead of attending daily or almost daily appointments. Medicare will cover these services as long as a licensed medical professional enrolled in the Medicare program provides them. In other words, Medicare does not cover services from licensed counselors.
As long as the services you’re receiving are considered “medically necessary,” the coverage has no limits. However, you should look over any Local Medical Review Policies (LMRPs) that your Part B carrier has in place, as these may limit the number of visits covered for specific mental health services in your addiction treatment plan.
If you’re told a service is not covered and your provider believes it is medically necessary, you can attempt to appeal the denial.
4. Additional Services
Some services — such as home health or telehealth — can be beneficial in treating your substance use disorder. If your provider agrees, Medicare may cover these services. For instance, in-home skilled care services are covered for people with qualifying mental health conditions, even if they have no physical limitations.
So, if your provider determines that your addiction or co-occurring disorder (such as anxiety or PTSD) prevents you from safely leaving home, you may qualify for home health services.
Overcoming alcohol addiction takes time and intensive support. However, if you’re ready to take the next step toward recovery, Zinnia Healing can help. Get answers to your questions by reaching out to our staff at (855) 430-9439.
Do I Qualify for Medicare Coverage?
According to the U.S. Department of Health and Human Services, Medicare eligibility is not based on income. Some of the reasons why you may qualify for Medicare coverage include:
- Aged 65 years or older
- Entitled to Social Security disability benefits for at least two years
- Have a kidney transplant or permanent kidney failure requiring regular dialysis
Other eligibility requirements apply. For instance, you have to be a permanent legal resident or citizen of the United States.
If you qualify for Medicare coverage, you are not obligated to enroll. If you sign up, you will not have to pay a premium for Part A coverage. However, you must pay a monthly premium for Part B coverage.
If you don’t keep up with your monthly Part B premium, your coverage will likely terminate after three months. Note that state medical assistance may help cover the costs, especially for lower-income households.
How Much Does Medicare Cover?
Medicare once had separate reimbursement rules for specific psychiatric services. However, in July 2009, the government issued the Medicare Improvements for Patients and Providers Act (MIPPA), which increased the percentage that Medicare covers regarding mental health services.
The law took effect in 2010. By 2014, Medicare began reimbursing mental health services at 80% of the approved rate, the same as for other Part B claims.
You are responsible for 20% of any covered mental health services costs. However, you can help bring down this cost even further through supplemental insurance coverage.
- If you are in a lower-income bracket, Medicaid may help cover Medicare co-insurance and provide additional mental health benefits.
- Purchasing Medicare Supplemental Insurance (Medigap) from a private insurer can help reduce your out-of-pocket costs.
The majority of people enrolled in Medicare have Original Medicare. However, you have the option to choose from a set of Medicare Advantage plans, which include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Private Fee-For-Service (PFFS) plans.
In addition, specific Medicare Advantage plans are tailored to certain conditions, including substance use disorder, and may offer better coverage.
Wondering If Your Insurance Covers Alcohol Rehab? Zinnia Healing Can Help
Understanding your health insurance coverage can be confusing, but that shouldn’t stop you from receiving the care you need. You can often cover the cost of mental health care through your insurance company or by exploring several other options.
If you’re worried about affording treatment for alcohol abuse, contact a licensed treatment facility to help you understand your options.
A healthcare provider or recovery specialist at Zinnia Healing can answer your questions about coverage. Call our helpline at (855) 430-9439 for more information.