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  • If you have Medicare, you’re likely covered for medically necessary inpatient or outpatient treatment for substance use disorder. This can include a drug detox plan, a stay at an inpatient treatment center, prescription drugs for treatment, and other costs.

    Healthcare services covered by Medicare may need to be certified by your doctor and other medical professionals. Additionally, some aspects of your treatment may not be covered by your specific medical insurance program. Medicare plans may vary even between patients.

    How Medicare Covers Your Treatment Program

    Medicare is a federal health insurance plan that covers many different medical needs. Many forms of substance abuse and addiction treatment are covered by the various parts of Medicare

    Forms of Medicare coverage that relate to drug abuse and drug addiction treatment include:

    • Medicare Part A: covers inpatient care at a treatment center or psychiatric hospital
    • Medicare Part B: covers outpatient care, mental health treatment, and some prescription drugs that may be needed for treatment
    • Medicare Part C: covers additional costs that may not be covered by parts A and B
    • Medicare Part D: covers prescription drug plans as part of addiction treatment

    Your eligibility for coverage may not include all four parts. Medicare that only includes parts A and B is known as original Medicare. Plans which include all four coverage options are often known as Medicare Advantage plans, which may be run by private insurance companies.

    Medicare & Other Treatment Services

    Every recovery timeline for substance abuse is different. The wide-range of Medicare coverage will help your costs stay low even in severe cases of substance abuse.

    Medicare Part A also covers hospital stays that may have been caused by a drug overdose. An overdose may be a warning sign that you need continued treatment. If you are undergoing a drug detox as part of inpatient treatment, this also falls under Medicare coverage.

    Most forms of SBIRT coverage (screening, brief intervention, and referral to treatment) are covered by Medicare Part B. SBIRT is helpful in identifying and keeping track of patients with substance abuse issues. 

    Part B also covers mental health care services, including forms of individual and group therapy.

    What Medicare Does Not Cover For Rehab

    Medicare only covers parts of treatment services that are considered medically necessary. Some substance abuse treatment services may include parts that do not fall under this category.

    Parts of treatment that may not be covered by Medicare include:

    • private rooms
    • personal items
    • comfort options inside the treatment facility

    Other Costs Not Covered By Medicare

    Depending on your situation, you may still need to pay a deductible or coinsurance cost for drug rehab covered by Medicare. If you have not met your deductible, you may still need to pay out-of-pocket before Medicare starts to cover your costs.

    Some Medicare plans also have coinsurance costs where the provider and the receiver of the insurance split costs. Coinsurance costs usually start after you have met your deductible. Your deductible and coinsurance fees may vary depending on the type of Medicare you have.

    Find Treatment Options Covered By Medicare Today

    Medicare can help make treatment programs more accessible to people who need them. Having health insurance can help you put the well-being of you and your loved one over financial costs.

    If you’re looking for substance abuse treatment providers covered by Medicare, resources are available. To find the best treatment options that are covered by your insurance, talk to your healthcare provider or contact us today.

    Written by Ark Behavioral Health Editorial Team
    ©2023 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    Medicare.gov - Inpatient Rehabilitation Care Coverage
    Medicare.gov - What's Medicare?
    Substance Abuse And Mental Health Services Administration - Coding for Screening and Brief Intervention Reimbursement | SAMHSA

    Medically Reviewed by
    Kimberly Langdon M.D.
    on June 24, 2022
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