Does Medicare Pay for Drug Rehab?
The Affordable Care Act made changes to Medicaid and Medicare allowing more people to access rehab. Learn more about Medicare rehab options here.
Takeaways from this article:
Medicare substance abuse coverage.
How to pay for rehab with Medicaid.
Will Medicare pay for drug rehab?
Substance abuse treatment facilities that accept Medicare.
Private health insurance covers a significant portion of the US population, but some people need additional help. Medicaid and Medicare are public insurance options that you may qualify for.
As of 2019, 61.4 million people were covered by Medicare Parts A or B in a given month. You may qualify for Medicare if you are 65 years of age or older, or permanently disabled. Medicaid had 75.8 million people covered in an average month. Those on Medicaid have a lower income and need assistance affording healthcare.1,
This page will help you understand if detox facilities and rehab are covered by Medicare and Medicaid and how you can use your coverage to receive the treatment you need.
Medicaid versus Medicare
Medicare and Medicaid are both health insurance options that are subsidized by the government, but they have important differences in both administration and how you qualify for coverage.
Medicare is a federally administered program that offers coverage for those 65 and older or those who are permanently disabled. Working Americans pay toward Medicare on every paycheck, and those deductions fund the program. Your income does not prevent you from qualifying for Medicare and the coverage is the same throughout the United States. There is a monthly premium for Medicare.
Medicaid is an assistance program for those who have lower incomes. Generally, patients pay no monthly premium and are not responsible for a deductible, although there may be a small copayment for treatment. Medicaid is a state-based program that receives financial assistance from the federal government. Coverage and qualifications can vary from state to state.2
It’s possible to qualify for both Medicaid and Medicare at the same time. You might be 66 and in a lower income bracket, for example. If you’re in this situation, your Medicare premiums are generally waived. You’ll receive prescription drugs through Medicare prescription drug coverage (Part D), and Medicaid may give you additional coverage that Medicare doesn’t offer.3
Some rehabs may be covered by Medicaid and Medicare. Rehab programs must comply with the Affordable Care Act (ACA), which states that substance abuse coverage is an essential health benefit.4 Exactly which programs are covered and what services you receive may vary depending on your specific state and plan options.
How Does the ACA Effect Rehab Benefits?
The Affordable Care Act (ACA), also known as Obamacare, went into effect in 2010 and made significant changes to health insurance coverage. One of the biggest is the list of essential health benefits that must be included in every insurance plan — including Medicare and Medicaid.5
All plans must cover mental and behavioral health inpatient services, behavioral health services such as psychotherapy and counseling, and substance use disorder treatment. Treatment cannot be denied due to a preexisting condition, including previous substance use disorders.
All of these stipulations apply to Medicare and Medicaid, meaning that you’ll be able to get at least some coverage for detox and rehab. However, you’ll still have to make sure that the specific program you select is among those drug rehabs that take Medicare or Medicaid.
How to Find Rehabs that Accept Medicaid or Medicare
Finding providers who accept Medicaid or Medicare isn’t always easy. It will require research and communication with Medicare and Medicaid representatives to determine what parts of substance abuse treatment are covered.
The Substance Abuse and Mental Health Services Administration offers a website focused on helping you find treatment.6 At FindTreatment.gov, you can search for treatment options near you.7 When you search, you can choose the payment options available for you, including Medicaid or Medicare. If you have both, Medicare pays first, so you can select that option.
You can choose from a variety of other alternatives as well. For instance, you can search for an inpatient or outpatient program specifically, or a program focused on veterans or LGBTQ people.
While you may not find a program that checks all your boxes, you can find the one that’s best for your situation. This may mean prioritizing parts of treatment based on need. For example, if you are looking for medical detox, this is a great way to start narrowing down facilities. Finding a facility that offers medical detox and accepts Medicare or Medicaid can be an important start to finding treatment. For more information about how to find state-funded rehab programs in your area, review our guides below:
- Centers for Medicare & Medicaid Services. (2020). CMS fast facts.
- Health and Human Services. (2015). What is the difference between Medicare and Medicaid?
- Medicare Government Site. Help paying for costs, Medicaid.
- Healthcare.gov. Mental health & substance abuse coverage.
- Healthcare.gov. What Marketplace health insurance plans cover.
- Substance Abuse and Mental Health Services Administration. Homepage.
- FindTreatment.gov. Homepage.