Both Original Medicare and Medicare Advantage plans cover various treatment options for substance use disorder, including inpatient care, outpatient care, and prescription medications.

Both Original Medicare and Medicare Advantage plans cover various types of treatment for substance use disorder, including inpatient care, outpatient care, and prescription drugs.

In this article, we’ll discuss Medicare coverage options for substance use disorder treatment.

If you’re a Medicare beneficiary, you’re covered for many of the treatment options currently available for substance use disorder. Here’s how Medicare covers these treatments:

  • Medicare Part A covers inpatient hospital care and inpatient care in a rehabilitation facility or hospital.
  • Medicare Part B covers outpatient mental health services, alcohol misuse screenings, and other behavioral health services.
  • Medicare Part C covers anything already included under Medicare parts A and B, plus extras such as prescription drug coverage.
  • Medicare Part D covers certain prescription drugs that may be necessary to treat substance use disorder.
  • Medigap plans cover certain expenses related to your Original Medicare plan, such as deductibles, copayments, and coinsurance.

Medicare Part A, or hospital insurance, covers any necessary inpatient hospitalization for substance use disorder and inpatient care in a rehabilitation facility or rehabilitation hospital.

  • inpatient hospitalization
  • inpatient drug rehabilitation services
  • coordinated care from nurses and doctors
  • any drugs necessary during inpatient treatment

Eligibility

You qualify for inpatient rehabilitation under Medicare Part A if your doctor has certified that it’s a necessary treatment for your condition.

Costs

There are costs associated with inpatient hospitalization and rehabilitation services under Medicare Part A. These Part A costs include:

  • Deductible: For Part A, this is $1,632 per benefit period in 2024.
  • Coinsurance: If your inpatient stay lasts longer than 60 days, you’ll pay $408 each day for days 61 through 90 and $816 for each lifetime reserve day (days 91 through 150) used during the benefit period. After 150 days, you’ll need to pay all costs.

Medicare Part B, or medical insurance, covers outpatient mental health counseling, alcohol misuse screenings, and intensive outpatient programs for substance use disorders.

In some instances, Medicare will also cover services related to Screening, Brief Intervention, and Referral to Treatment (SBIRT). These services are intended to help those who may be at risk of developing substance use disorder. Medicare covers SBIRT services when they are deemed medically necessary.

Eligibility

You qualify for these outpatient treatment services under Medicare Part B if your doctor or counselor accepts Medicare assignment. You must also have paid your Part B deductible and premiums to get coverage.

Costs

The costs for Medicare Part B include:

  • Premium: This is usually $174.70 per month but may be higher, depending on your income.
  • Deductible: In 2024, this is $240 for the year.
  • Coinsurance: You may owe a certain amount for services you receive — usually 20% of the Medicare-approved cost after you’ve met your deductible.

Medicare Part D is an add-on to Original Medicare that helps cover the cost of prescription drugs. You can use it to cover medications you need during treatment for substance use disorder.

Most Medicare Advantage, or Medicare Part C, plans also offer prescription drug coverage.

Drugs that may be used to treat opioid, alcohol, or nicotine use disorders include:

Each prescription drug plan has its own formulary (a list of approved drugs). Drugs are arranged in tiers, from the least expensive generic drugs to the more expensive brand-name drugs. The drugs listed above may range in cost according to the tier and whether the drug is brand-name or generic.

Costs

Adding on a Medicare Part D plan comes with the following additional costs:

  • Premium: This amount will vary depending on the plan you enroll in, your location, and other factors.
  • Deductible: This amount will also vary depending on your plan but cannot be more than $545 in 2024.
  • Coinsurance or copayments: These will differ for each drug you’re prescribed.

Medigap plans

Medigap, or Medicare supplemental insurance, is an add-on plan that helps cover some of the costs from your other Medicare plans. If you need treatment for substance use disorder, having a Medigap plan may help cover costs such as:

  • your Medicare Part A deductible and coinsurance
  • your Medicare Part B deductible, premium, and coinsurance
  • blood for transfusions (up to 3 pints)
  • medical costs during foreign travel

To enroll in a Medigap plan, you must already be enrolled in Medicare parts A and B. You can enroll in Medigap through a private insurance company that sells plans.

Medicaid

Some Medicare beneficiaries are also eligible to apply for Medicaid. Medicaid is another health insurance option that helps cover people with lower incomes. If you’re eligible, you can use Medicaid to help cover treatment costs.

You can call your local Medicaid office for more information and find out whether you’re eligible for coverage.

Financing

Some rehabilitation facilities offer financing options that allow you to pay for your services later, such as payment plans. Financing can be helpful if you need immediate treatment for substance use disorder but don’t have the funds set aside to pay for it up front.

Although much of your treatment will be covered, as described above, there are a few things that aren’t included that you should know.

Part A

Medicare Part A does not cover private nursing, a private room, or other added amenities during your inpatient hospital stay.

Part B

Medicare Part B does not cover any hospitalization or services associated with inpatient care, as these are generally covered under Medicare Part A. Any medical equipment that is not deemed medically necessary or “durable medical equipment” will also not be covered.

Parts C and D

Not all drugs are covered under Medicare Part D or Medicare Advantage plans. However, all Medicare prescription drug plans are required to cover antidepressants, antipsychotics, and anticonvulsants. If these medications are prescribed for substance use disorder, they will be covered by your drug plan.

Finding help

If you think you or someone you love has a substance use disorder, there are resources that can help:

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has a 24-hour helpline that you can reach at 800-662-HELP (4357).
  • You can also visit SAMHSA’s website to learn more about the available programs and initiatives that can help.

If you or a loved one has a substance use disorder and is enrolled in Medicare, you can rest assured that Medicare will cover almost all the necessary treatment.

Inpatient hospitalization or rehabilitation stays are covered under Medicare Part A. Supportive outpatient services and programs are covered under Medicare Part B. Some prescription drugs for treatment are covered under Medicare Part D or Part C.

If you or someone you know needs help for substance use disorder, getting the proper treatment is critical. Reach out to a healthcare professional to find a treatment program near you.