Medicare coverage for addiction support: 5 steps on the road to treatment and recovery 

Dealing with addiction can be extremely daunting and confusing. When you’re ready to seek addiction treatment, navigating health insurance can feel like yet another roadblock in your path. But if you’re over 65 and on Medicare, we can help you understand your coverage and take steps toward addiction treatment and recovery

Step one: Understanding Medicare basics

Before we get into specific coverage for addiction treatment, here’s a little of the basic structure Medicare:

• Medicare Part A: Hospital Insurance: covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health care.
• Medicare Part B: Medical Insurance: covers certain doctors’ services, outpatient care, medical supplies and preventive services.
• Medicare Part C: Medicare Advantage Plans: an alternative to Original Medicare (Part A and B) offered by private companies approved by Medicare.
• Medicare Part D: Prescription Drug Coverage: adds prescription drug coverage.

Step 2: Discover how Medicare pays for substance use disorder treatment

The short is answer is, yes, Medicare does pay for (also known as “covers”) substance use disorder treatment. But how much coverage depends on the specific Medicare plan and type of services.

1. Inpatient Treatment

Medicare Part A covers substance use inpatient care in hospitals and specialized psychiatric hospitals, including:

• Room and board
• Nursing care
• Therapy and treatment services
• Medications administered during your stay

2. Outpatient Treatment

Medicare Part B covers outpatient treatment for substance use disorders such as:

• Individual and group therapy
• Patient education on diagnosis and treatment
• Post-hospitalization follow up
• Outpatient prescription drugs given in a doctor’s office or hospital setting
• Structured Assessment and Brief Intervention services

3. Partial Hospitalization Programs (PHP)

Medicare covers PHPs, which provide intensive outpatient care and structured psychiatric services for those who don’t require 24-hour care. This may include:

• Individual and group therapy
• Occupational therapy
• Family counseling
• Patient education
• Activity therapies
• Medication management

4. Medication-Assisted Treatment (MAT) (also know as Medications for Substance Used Disorders)

Medicare coverage for medication-assisted treatment for opioid use disorder, alcohol use disorder or other substances of use may include:

• Dispensing and administration of FDA-approved opioid treatment medications (such as methadone, buprenorphine, and naltrexone)
• Substance use counseling
• Individual and group therapy
• Toxicology testing

5. Telehealth Services

Medicare expanded its coverage of telehealth services since the COVID-19 pandemic and includes:

• Psychotherapy
• Counseling
• Medication management

6. Prescription Drug Coverage

Medicare Part D plans include coverage for medications used for treating substance use disorder, including:

• Buprenorphine
• Naltrexone
• Methadone (when prescribed for pain)
• Antabuse
• Acamprosate

Step 3: Navigating out-of-pocket costs

Medicare may not cover all the costs of your care. And out-of-pocket costs aren’t always pocket change. So even with Medicare coverage, it’s important to understand additional costs you could be responsible for, including:

• Inpatient care–the Medicare Part A deductible for each benefit period, plus coinsurance for extended stays.
• Outpatient services–typically 20% of the Medicare-approved amount after meeting the Part B deductible.
• Partial hospitalization programs–a % of each service and possibly coinsurance or copayments.
• Prescription drugs–costs vary depending on your specific Part D plan.

If you have a Medicare Advantage plan (Part C), costs and coverage may be different from Original Medicare. It is best to ask about specific plan details.

Step 4: Explore additional help

Navigating Medicare coverage for addiction treatment can feel impossible. The good news is, there’s help. Here are a few tips on how to find it.

• Speak with a healthcare provider who helps determine treatment and if it’s covered.
• Contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
• Check with treatment providers–like Better Life Partners, that can help verify and explain coverage.
• Consider supplemental insurance, like a Medigap policy, to cover out-of-pocket costs if you have
• Original Medicare.
• Explore Medicare Advantage Plans for coverage beyond Original Medicare.
• Look into state programs which may offer additional assistance.

Step 5: Reach out to Better Life Partners, your guide on the journey toward treatment and recovery

Effective addiction treatment deals with a person’s substance use as well as their social, physical and mental health. The Better Life Partners team can partner with you to create a plan that meets your personal needs and goals. And our services are covered by Medicare, including:

• Medication-assisted treatment (MAT)
• Individual and group counseling
• Care coordination
• Recovery coaching

We can help verify your Medicare coverage, explain your options, and guide you toward the treatment that’s right for you. It’s possible to move beyond addiction toward a healthier life filled with belonging, love, and purpose. Your path is unique, and at Better Life Partners, we’re committed to walking with you, every step of the way.

Sources:
American Addiction Centers – Quick Facts on Drug Addiction
Medicare.gov – Mental health care (inpatient)
OASAS – SBIRT: Screening, Brief Intervention & Referral to Treatment
Medicare.org – Does Medicare Cover Methadone?