Substance Abuse Treatment

What to Know About Inpatient Care If You Have Medicare

What to Know About Inpatient Care If You Have Medicare

Are you part of the 44 million people (15% of the population!) receiving Medicare services?

If you or a loved one is struggling with substance addiction, you may be wondering about which treatment options are available for support.

We’re here to thoroughly explain Medicare rehab centers so you can make an informed decision for your care.

Let’s get into it!

What is Medicare?

Medicare refers to America’s universal health insurance program for people ages 65 and older. Employees and employers throughout America fund Medicare via payroll taxes.

Furthermore, individuals younger than age 65 with certain disabilities including Lou Gehrig’s disease and permanent kidney failure, may qualify for Medicare.

There are currently four parts to Medicare.

Medicare Part A- Hospital Insurance

This assist in paying for inpatient care in a hospital or specific facility. It may also help pay for hospice or home health care.

Medicare Part B- Medical Insurance

This part is similar to that of standard health insurance. It helps covers a variety of services facilitated by doctors and healthcare providers. It may also cover medical equipment and preventive services.

Part C- Medicare Advantage

Part C entails all the benefits and services integrated with Parts A and B. Some of these plans include prescription drug coverage and additional benefits.

Part D- Medicare Prescription Drug Coverage

Part D refers to covering the costs of prescription medication.

In general, you’re eligible for free Medicare if you are:

  • Over age 65
  • Receive social security benefits (or your spouse does)
  • Worked long enough in a government job where you paid Medicare taxes
  • A dependent parent of a fully insured deceased child

Even if you don’t meet these requirements, you may still be eligible for a plan by paying a monthly premium during the enrollment period.

Does Medicare Cover Treatment?

In short, yes, Medicare can subsidize drug and alcohol treatment. However, individuals must meet certain criteria and understand specific requirements before seeking out Medicare rehab centers.

When It’s Covered

Typically speaking, drug and alcohol addiction is covered by Medicare if:

  • Your health care provider deems services as medically necessary
  • You receive services from a Medicare-approved facility or provider
  • Your provider sets up your treatment plan of care

These are the first steps any individual should take before locating Medicare rehab centers on their own.

Services Covered

Common covered Medicare services include most of the essential components of addiction treatment. This includes:

  • Psychoeducation about diagnosing and treatment
  • Individual, family, and group therapy services
  • Post-hospitalization follow-up
  • Prescription drugs administered in the hospital or doctor’s office

It’s always best practice to double-check eligibility for each of these services to make sure they are covered.

Specific Medications

Many people take methadone or similar medications for substance addiction treatment. Methadone may be covered in inpatient hospital settings, but Medicare will not cover it if it is supplied orally in an outpatient clinic.

For Part D (Medicare prescription benefits) plans, outpatient prescription drugs are covered (if they treat substance abuse). But, they do not cover methadone or similar medications for substance abuse treatment.

Inpatient Care

Part A (Hospital Insurance) will cover your care if you are hospitalized and referred for substance abuse treatment. With that in mind, your plan’s cost-sharing rules for inpatient stays will apply.

It is important to note that Medicare currently only covers a lifetime of 190 inpatient days.

Outpatient Care

Part B (Medical insurance) covers outpatient substance addiction services typically administered in hospitals or freestanding clinics.

The original Medicare plan covers all comprehensive mental health services (which includes substance addiction) at 80% of the approved Medicare amount.

If you receive services from eligible, participating Medicare rehab centers, you will pay a 20% coinsurance after meeting your deductible rates.

However, if you are enrolled in Medicare Advantage, you will need to reach out to your plan’s administrator for details regarding coverage and cost of treatment.

What About Medigap?

Some people may use Medigap, which is Medicare Supplemental Insurance, to help pay for health care costs associated with addiction.

Medigap can help with deductibles, coinsurance, and copayments, and it is sold by private companies.

Typically, your Medicare plan will pay for its approved amount of covered health care costs, and then your Medigap policy will start paying out.

You must have Medicare Part A and Part B to apply for Medigap, and your policy will only cover one person.

How to Find the Best Treatment

Once you’ve established your plan’s eligibility and limits, it’s time to start making an informed search.

Keep in mind that Medicare rehab centers are all around the country. Many people benefit from attending treatment out-of-state. This eliminates common distractions, such as family or home obligations, that may deter your successful treatment.

When you call around different treatment centers, it’s important to gain a “strong feel” for each facility. You should feel encouraged to ask questions and seek out advice. You should feel like you’re being treated like a person, rather than just another patient.

If you decide to attend treatment locally, you might want to inquire about taking a short tour of the facility. This will give you a chance to interact with different staff and providers and get a picture of what to expect.

Final Thoughts on Medicare Rehab Centers

If you or a loved one is struggling with a drug or alcohol addiction, help and recovery are always available.

For many, the first step towards building a new life is reaching out for support and locating a quality treatment center.

Are you interested in learning more about addiction treatment and trends? Be sure to check out our blog today!

About the author

Dr. Michael Carlton, MD.

Leading addictionologist, Michael Carlton, M.D. has over 25 years of experience as a medical practitioner. He earned a bachelor’s degree in Mechanical Engineering and returned for his MD from the College of Medicine at the University of Arizona in 1990. He completed his dual residency in Internal Medicine and Pediatrics and his Fellowship in Toxicology at Good Samaritan Regional Medical Center and Phoenix Children’s Hospital.

He has published articles in the fields of toxicology and biomedicine, crafted articles for WebMD, and lectured to his peers on medication-assisted treatment. Dr. Carlton was a medical director of Community Bridges and medically supervised the medical detoxification of over 30,000 chemically dependent patients annually.

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