Medicare is a publicly funded program covering many aspects of healthcare for United States citizens who are 65 and older, young individuals with certain disabilities, and individuals with end-stage kidney disease requiring transplant or dialysis. The original Medicare program offered two parts: Part A, which covered inpatient or hospitalization, and Part B, which covered other necessary health care options through an insurance program. There are also two other parts to modern Medicare: Part C, also called Medicare Advantage Plans, which are private insurance companies that are approved to work with Medicare, and Part D, which covers prescription medication.
Since Medicare is geared toward specific demographics, the overall focus of the program is not specifically on mental, behavioral, or substance abuse treatment; however, the parts in Medicare can be used to cover mental health and substance abuse treatment programs.
When you’re worried about your patterns around drugs or alcohol, you may consider addiction treatment. If you have Medicare, you can use the parts of the program to cover some aspects of your treatment in different ways. Some of this will depend on where your treatment needs fall on the Continuum of Care, which has been defined by the American Society of Addiction Medicine (ASAM).
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The three parts of Medicare that are directly funded by the federal government are Parts A, B, and D. These programs can be used to cover addiction treatment.
This part of the Medicare program covers hospitalization, so if you are hospitalized due to mental health or substance abuse, Part A manages those costs. This includes your hospital room, meals, nursing care, and related supplies and services. Part A does not cover some parts of inpatient hospitalization, such as:
The first 60 days (two months) of hospitalization have $0 coinsurance per day, days 61 to 90 have a $335 coinsurance cost per day, and day 91 and beyond have a $670 coinsurance cost per day.
This part can be applied to outpatient treatment services, like appointments with physicians, therapists, and social workers. Since these medical professionals are core people in addiction treatment, Part B can help you cover the cost of these visits when you are going through addiction treatment. Specific outpatient services may be covered by Part B.
Other treatment approaches may be covered by Part B:
Part B may cover partial hospitalization, especially when Part A does not cover this approach to inpatient treatment. This part manages outpatient or partial-outpatient options as treatment alternatives to living in a facility, especially when that facility is a hospital. Along with some of the outpatient program, Medicare may also cover:
Medicare Part B will not cover the following:
This part of the Medicare program is more likely to have copayments associated with it. For example, if a therapist approves the use of your Medicare coverage for their outpatient treatment, you will still pay a percentage of this treatment. The standard Part B premium is $134 as of 2018, and the deductible and coinsurance are $183 per year. After the deductible is met, you will pay 20 percent of the approved amount.
Prescription medications are covered by Part D, and this can include psychiatric medications for depression or anxiety, some medication-assisted treatments like buprenorphine (but not methadone), and drugs used to treat chronic conditions from long-term substance abuse. The cost of Part D varies based on monthly premiums.
Although methadone is one of the most used approaches to tapering off long-term opioid abuse, Medicare does not cover this option, although an estimated 300,000 Medicare patients have been diagnosed with an addiction to opioid narcotics. However, Part D may cover buprenorphine, which can be administered by a trained physician for outpatient detox use.
You may also be able to apply Part C to substance abuse and addiction treatment programs, but Part C is private insurance, so your coverage will vary based on which Medicare-approved private insurer you work with.
Because Medicare is a federal program, there is little difference by state. The “original” Medicare parts, A and B, are the same across all 50 states in the U.S. Part D may vary across state lines, based on how the local and state governments regulate pharmacies. You should receive good coverage for your treatment no matter where you live. If you are concerned about how Medicare can help you, don’t forget, social workers are covered by Part B. Your questions can be answered in that appointment. Navigating the complexity of Medicare can be daunting, but you don’t have to do it alone. If you or a loved one is ready to escape the trap of substance addiction, call Ocean Breeze Recovery today. Our team of addiction professionals is standing by to guide you to the help you need. So, don’t delay. Call 844-554-9279 or contact us online today.
(September 11, 2014) Who Is eligible for Medicare? U.S. Department of Health and Human Services. Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
How Do Medicare Advantage Plans Work? Medicare.gov. Retrieved from https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
Drug Coverage (Part D). Medicare.gov. Retrieved from https://www.medicare.gov/part-d/
(May 13, 2015) What Are the ASAM Levels of Care? Continuum: The ASAM Criteria Decision Engine. Retrieved from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
(March 19, 2018) Health Insurance and Mental Health Services. MentalHealth.gov. Retrieved from https://www.mentalhealth.gov/get-help/health-insurance
Your Medicare Coverage: Mental Health Care (Inpatient). Medicare.gov. Retrieved from https://www.medicare.gov/coverage/inpatient-mental-health-care.html
Your Medicare Coverage: Mental Health Care (Outpatient). Medicare.gov. Retrieved from https://www.medicare.gov/coverage/outpatient-mental-health-care.html
Your Medicare Coverage: Alcohol Misuse Screening & Counseling. Medicare.gov. Retrieved from https://www.medicare.gov/coverage/alcohol-counseling.html
Your Medicare Coverage: Smoking & Tobacco Use Cessation (Counseling to Stop Smoking or Using Tobacco Products). Medicare.gov. Retrieved from https://www.medicare.gov/coverage/smoking-and-tobacco-use-cessation.html
Your Medicare Coverage: Mental Health Care (Partial Hospitalization). Medicare.gov. Retrieved from https://www.medicare.gov/coverage/partial-hospitalization-mental-health-care.html
Medicare 2018 Costs at a Glance. Medicare.gov. Retrieved from https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
(April 24, 2018) Medicare Doesn’t Cover Methadone Treatment. Here’s How Congress Can Change That. PBS News Hour. Retrieved from https://www.pbs.org/newshour/health/medicare-doesnt-cover-methadone-treatment-heres-how-congress-may-change-that