Medicare for Drug Rehab: When Is it Accepted?

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. 

What Are the Treatment Levels?

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). 

• Level 0.5, Early Intervention: This level covers education and prevention programs for people who are at risk of developing an addiction. For people who are covered by Medicare, this may look like a discussion between you and your physician before you take a new prescription medication, so you can work together to reduce the risk of abusing that drug
• Level 1, Outpatient Treatment: Generally, this represents nine hours or less per week of recovery or counseling services. Outpatient rehabilitation programs, for example, meet for an hour or two per day, with flexible scheduling for day or evening availability. If you need outpatient rehabilitation services, you may only need to go two or three days per week. Medicare may cover some options of care at this level
• Level 2, Intensive Outpatient and Partial Hospitalization: Intensive outpatient programs (IOPs) involve more than nine hours of counseling or treatment per week, with less scheduling flexibility. Partial hospitalization involves 5-6 hours a day for 5 days a week for a few days to a couple weeks followed by stepping down to an intensive outpatient treatment program
• Level 3, Inpatient Treatment: This level involves staying in a facility for one to three months, spending most of the day focusing on approaches to behavioral therapy and recovery. Inpatient treatment is important for people who cannot stay away from substances in their current home environment or whose home environment is too unstable to support their recovery
• Level 4, Medically Managed Intensive Inpatient Services: This level of inpatient treatment is not just for people who need to leave their home environment but also for individuals who have been physically harmed by abusing drugs or alcohol for a long time. They need consistent access to nursing care, prescription medications, and other medical interventions for a long time to remain physically stable while also going through addiction counseling. 

Which Parts of the Medicare Program Can Help with Drug Rehab?

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. 

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. 

Consistent Drug Addiction Treatment

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.