Rehabs are expensive. Can Medicare help you fund your treatment?
The answer is yes in some cases, but no for others.
Who is eligible for Medicare rehabilitation benefits.
Nearly 50 million American’s receive Medicare coverage. Treatment for substance abuse and addiction IS covered by Medicare. But the program can be picky about who receives funding for rehab.
Insurance coverage inpatient/outpatient treatment through Medicare must meet these criteria:
- The center that provides your rehabilitation service must be a Medicare-approved facility.
- Your doctor determines that these services are deemed a medical necessity.
- A full treatment plan is created by the doctor for you to follow.
The medicare program will cover a portion of the total health care cost. This varies by 50-80 percent for mental health care services, drug and alcohol addiction treatment falling into this category. Though the treatment MUST be deemed to concur with Medicare’s medical necessity standards.
There are four types of Medicare Coverage
If you are approved for coverage by Medicare then you’re treatment may fall under different categories:
Medicare Part A Coverage
This plan covers costs for inpatient drug & alcohol treatment. This includes food, nursing, housing and other services in the hospital or treatment center. Coverage should be pretty thorough, just leaving you to pay out-of-pocket as much as you would for any hospital stay. (If your treatment takes place in a purely psychiatric hospital then Medicare will cover up to 190 days of treatment. Beyond that 190 days coverage can only continue if received in a general hospital)
Medicare Part B coverage
This plan covers outpatient treatment, blood panels and some specific services by substance abuse staff. It also covers diagnosis by Medicare-approved doctors. This includes the creation of your treatment plan and follow up care. Coverage for therapy (group or individual) is also covered by part B. This plan does not include prescription drug coverage, which would be covered under a Part D plan.
Medicare Part C Coverage
If you have the Medicare part C plan (also called Medicare Advantage Plans) it should cover all costs included in Part A and Part B coverage. Sometimes it will cover even more, as there can be extra services allowed.
Medicare Part D Coverage
For Medicare Part D prescription drug plans you may be covered for medication prescribed by a doctor as part of your drug or alcohol treatment regimen. Co-payments will vary, so contact your plan provider.
How much will Medicare cover?
- 50% coverage for outpatient treatment services.
- 80% coverage for services of a treating physician
- 65% coverage for mental health care services
Remember that your care must be considered “medically necessary”, deemed so by a licensed physician or medical provider.
Your care must be provided by a caretaker who participates in the Medicare program.