Recovering from Addiction with Medicaid and Medicare

recovering with medicaid and medicare

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Under the Patient Protection and Affordable Care Act (PPACA) of 2010, otherwise known as the Affordable Care Act (ACA), or “Obamacare,” all insurance providers in the Health Insurance Marketplace are required to provide coverage for basic elements of addiction treatment.

This includes Medicaid and Medicare. Medicare and Medicaid offer plans with low or non-existent co-pays that cover a range of substance abuse and addiction treatments, including rehab.

What is Medicaid and who qualifies?

Medicaid is a public program that provides insurance coverage for individuals and families who might not otherwise be able to pay premiums associated with private insurance coverage.

To be considered eligible for Medicaid, applicants must be one, or more, of the following:

  • Over 65 years old
  • Under 19 years old
  • Pregnant
  • A parent
  • Within a specified income bracket*
People can only apply for Medicaid based on income alone if their state has expanded its Medicaid coverage.

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What is Medicare and who qualifies?

Medicare is a public program that provides insurance coverage to people over the age of 65 or to those with disabilities.

People often seek the assistance of Medicaid because they often have medical expenses that are much higher than the average person.

Can One apply for both Medicaid and Medicare?

If one is 65 or older, or have a disability, one may be eligible to apply for both Medicare and Medicaid.

Can One apply for Medicaid or Medicare if One already has private insurance coverage that doesn’t cover addiction treatment?

A person who already has private health insurance can apply for Medicaid assistance if:

  • The individual demonstrates financial need
  • Proves one is unable to pay current premiums

What Drug and Alcohol Addiction Treatment Options do Medicaid and Medicare Cover?

Because Medicaid and Medicare are not their own health care providers but are instead each made up of a network of approved professional practices, different plans cover different treatment methods.

How Can Medicaid Help Pay for Addiction Treatment?

In most states, Medicaid recipients do not have co-payments for addiction treatment services.

For the states that do require co-payments, there is an out-of-pocket limit that applies to Medicaid recipients.

Some of the addiction treatment methods Medicaid covers include:

  • Inpatient rehabilitation
  • Long-term residential treatment
  • Interventions
  • Behavioral therapies such as:
    • Individual therapy
    • Group counseling
    • Family behavior therapy
    • Cognitive-behavioral therapy
    • Other therapy methods
  • Medications* used to treat withdrawal symptoms and help those in recovery to stay sober, such as:
    • Methadone, Buprenorphine (with or without Naloxone), and Naltrexone to treat opioid use disorders
    • Acamprosate, Disulfiram, and Naltrexone to treat Alcohol use disorders
Some drugs require special permission or proof that the person is already enrolled in a treatment program in order to qualify for coverage.

How Can One Use Medicare to Pay for Drug and Alcohol Addiction Treatment?

Medicare has four different parts, all of which help to cover different types of costs for alcohol and drug addiction treatment.

Parts A and B are part of “Original Medicare,” whereas Part C, known as “Medicare Advantage,” can serve as an upgraded version of Parts A and B, and part D is an optional addition for those who want to increase the types of costs covered by their insurance.

Part A— Inpatient hospital visits

Medicare Part A, or can help those suffering from addiction by

  • up to 60 days in inpatient rehab*
  • medications received in rehab

Medicare will only cover a total of 190 inpatient visits of any kind in someone’s lifetime.

Part B— Office visits and other outpatient medical services

Medicare Part B can help cover these drug and alcohol treatment costs:

  • Outpatient rehab
  • Therapy/ counseling
  • Medications administered by clinics
  • Medications received during an intervention
  • Treatment and medication for co-occurring disorders, like depression.

Part C— Additional coverage through approved private insurers

Medicare Part C is optional for Medicare subscribers. As a standard, Part C is required to cover at least what’s covered by Part A and Part B, but can often provide additional benefits, such as:

  • A wider range of provider options, should the person opt for a plant that includes out-of-network care
  • Lower medication costs via prescription drug plans

Part D—Prescription drug coverage

Part D is also optional. Medicare Part D can help lower the costs of medications used to treat addiction.

Do All Rehab Centers Accept Medicaid and Medicare?

Unfortunately, not every facility accepts Medicaid and/or Medicare; however, all state-funded rehabilitation facilities do.

To find out more information about state-funded rehab centers, visit SAMSHA.gov.

View Sources
  1. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington (DC): US Department of Health and Human Services; 2016. CHAPTER 6, HEALTH CARE SYSTEMS AND SUBSTANCE USE DISORDERS. https://www.ncbi.nlm.nih.gov/books/NBK424848/.
  2. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Medicare Coverage of Substance Abuse Services. 2016. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1604.pdf.
  3. MEDICAID MANAGED CARE INFORMATION RESOURCE CENTER. Coverage and Delivery of Adult Substance Abuse Services in Medicaid Managed Care. 2014. https://www.medicaid.gov/medicaid/benefits/downloads/cms-adult-substance-abuse-services-coverage.pdf.

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  • Cindy
    I need help they keep changing my meds and I am getting worse
  • Tylu
    I’m Tyler Johnson been. Smoking meth for years I just won’t to better for my self I ever get high anymore security blanket for me I guess I really won’t some help please come get me if can help me
  • Carlos
    I been wanting to get help but it’s next to impossible if you don’t have insurance. You end up going into circles asking for help. Then you wait and nothing. I gave up. If someone found a better way to get help for detox, inpatient, and outpatient please please please send me the information. I’ll be so thankful.
    • Raven Kreps
      The same thing with us. We are in Mississippi. What state are you in?
    • R
      Hi Carlos, I understand how frustrating it can be. My friend needs rehab badly – did you manage to find anything out? Wishing you all the best in your journeyThanks
  • Peter Davidson
    I am on Medicare. I went to a Residential Recovery Program for 28 days in January 2019. The staff kept telling me Medicare would not cover my alcohol abuse behavior, so I paid $28,000.00 (twenty-eight thousand dollars) for my 28-day stay. I live in Santa Barbara. Was I misinformed? I don’t trust the staff at Cottage Residential Center.
    • Mark
      I got Medicaid and Medicare and I am about to find out if they will screw me too.I want off all of this so I can feel better..But they better not screw me.Its about the dull.payment not partial.
  • Stella
    Call the drug hotline for confidential help. They can guide you on how to get the help you need. 1-888-459-5511. But first right now ask Jesus Christ to help you. Tell Him you are sorry for the way you have been living your life and ask Him to forgive you and to help you and ask Him to save your soul. He will help you. I promise you that. Just tell Him you need His help. He will come to you. He still loves you no matter what you have done. He is the One who created you. He knows how to fix you back again and make you a new person again with a new clean start at life. Cry out to Him now ! Don’t wait any longer. You need His help now !! Jesus please helped this person as they cry out to you. Thank you Lord !!
  • SANDY
    I’m in such a bind I have had surgery 5 times to replace the metal in my elbow and shoulder sawed down twice two sergerys on my neck have 4 cadiver bones metal plates and screws too my lower back and tail bone had to be fused together with bone marrow and metal plates and screws rod now I got attached by a pitbull had to have another surgery on my other arm got stitches had to replace my nerves in my hand re route with wire I blacked out fell in the tub broke 5 ribs the had to be put right back in the hospital cause I would up getting double ppnemonia broke 2 ribs on my right side of the 3 MONTHS later my pain doctor burnt my nerves I in my lower back and hips on both sides NOW that’s not everything but I’m tired I have been on opiates and Xanax vallums Adderall alcohol anything to escape the physical and mental and emotional pain I got kicked out of the pain doctor and my primary care doctor kicked me out of her office cause she said she reffered me NO SHE DIDN’T I went to my nuerologist OTHI G JUST WROTE MY FAMILY A LETTER SAYING INEEDED 8 HOURS SLEEP UNINTERRUPTED what a joke then there’s Centerstone my little young kid new one AGAIN I told her everything is crazy she did nothing said she called in my seraquil and when I came back in 3 months I’ll have a new doctor AGAIN I have 3adult kids I have to take to work and pitup everyday a farm animals and even in the house 9 dogs well it’s alot all the house chores EVERYONE ignores me curse me I have no one to talk tomy old man is a great person doesn’t believe in drugs hates people drinking alcohol is not allowed on his property well there is so much I can’t say but I don’t know what I going to do my grandkids are my bueatiful babies I raised my grandkids and with my old man we have not seen them since December second cause I have to have emergency surgery the following morning she got mad cause she had to keep them also about money so please pray for me and my family my old mad is sick can’t breathe collapsed on the couch this is the second time in 4 weeks he doesn’t have insurance and refused to go to the hospital and want let me call 911 so I stay up shaking him and screaming his name so I can hear he is breathing I sit at the end of the couch to watch him WHAT CAN I DO I HAVE NO SUPPORT SYSTEM I LOVE JESUS CHRIST OUR LORD AND SAVIOUR PLEASE PRSY FOR MARK AND ME BRANDON AND TIFFANY AND JOSH MY GRANDKIDS SIERRA AND ELIJAH PLEASE THANKS ALOT SIGNED COMPLETELY ALONE AND CONFUSED I KNOW GOD IS WITH US JESUS CHRIST OUR LORD AND SAVIOUR IS WITH US BY THE POWER OF THE HOLY SPIRIT I CLAIM VICKTORY IN JESUS FOR YOU ALL AS WELL AS ME AND MY FAMILY GRANDBABIES
  • Lesley
    I feel your pain I’m here if you need to talk your friend Illinois
  • Tami Siekemeyer
    I need to get a program that is willing to take caresourse and I am willing to do whatever I takes to get the help that I need