Does Medicare Cover Drug Rehab?

Drug addiction is a problem for many, both young and old.

It could be an addiction to prescription drugs that started after a medical procedure. Or it could be an addiction to illegal drugs such as cocaine or heroin. Whatever the situation, drug rehab is one of the most common treatment options for those trying to break free of their addiction.

If you or a loved one is dealing with drug addiction, you may be looking into rehab options. And one thing you’re sure to find is that many of them are not cheap. Unfortunately not everyone who needs treatment in a rehabilitation center has the means to afford it.

So a common question for those who are eligible for Medicare have is, “Does Medicare cover Drug Rehab?” In this article, we answer the question in clear, plain English. You will also find the average costs of drug rehabilitation and other helpful info.

The short answer is yes; Medicare will cover the cost of drug rehab. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your drug rehab. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for drug rehab costs.

Part A

Medicare Part A provides coverage for inpatient care in a rehabilitation center or hospital. Medicare Part A’s coverage for drug rehabilitation includes:

Inpatient hospitalization
Inpatient drug rehabilitation services
The care given by the nurses and doctors
Medications that are necessary to treat your drug addiction and substance abuse while you are an inpatient

If your inpatient stay lasts for more than 60 days, you will pay $352 per day. If it lasts for more than 90 days, you will pay $704 per “lifetime reserve day.”

Part B

Medicare Part B also provides coverage for drug rehabilitation. It steps in when rehab takes place in an outpatient setting. Medicare Part B’s coverage for drug rehabilitation includes:

Mental health counseling
Alcohol misuse screenings
Individual or group therapy
Certain prescription drugs
Intensive outpatient drug rehabilitation
Outpatient hospital services

Sometimes, Medicare Part B may also cover Screening, Brief Intervention, and Referral to Treatment (SBIRT). Services related to SBIRT are meant for those who are or may be at risk of developing a drug addiction.

Medicare Part B covers 80% of the cost of drug rehabilitation services.

Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for drug rehabilitation. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

Part D

Medicare Part D also provides coverage for prescription drugs related to your substance abuse treatment. Drugs that may be used in the treatment of alcohol, opioid, or nicotine use and abuse may include:

Buprenorphine
Methadone
Naltrexone
Acamprosate
Bupropion
Chantix
Disulfiram

How Much Does Drug Rehabilitation Cost?

Some drug rehabilitation programs are free. But the average outpatient program cost between $1,000 to $1,500. And the average 30-day inpatient programs cost between $6,000 to $20,000 while 60-90-day inpatient programs cost $12,000 to $60,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.