Does Medicare Cover Rehab?
01/08/20: Addiction RecoveryThere are several parts to Medicare and each part has a role to play in coverage for rehabilitation. Medicare Part A, for example, covers rehabilitation care in a hospital setting. In some cases, Medicare may also provide coverage for rehab received in a skilled nursing facility. Medicare will pay for up to 100 days in a benefit period (which starts when first emitted to the hospital) for inpatient rehab after being in a hospital for at least 3 days. People often assume that these benefits only exist for rehab following surgery or a traumatic accident. While this is mostly true, Medicare does also provide coverage for drug and alcohol abuse rehabilitation.
Rehab Coverage and Original MedicareThere are some treatments and treatment plans that Medicare will not cover, so it’s always recommended that you call your carrier to confirm what is covered and what isn’t. Medicare generally can provide coverage for rehabilitation treatment for substance abuse. However, certain requirements and conditions must be met before Medicare approves coverage. Rehab for drug or alcohol abuse is only covered by Medicare if the following conditions are true:
- A provider must declare the services as medically necessary.
- A provider has established a written plan of care.
- Care is or will be received from a Medicare-approved provider at a Medicare-approved facility.
Part A CoveragePart A is the part of Medicare that provides your hospital benefits. Part A covers inpatient care at skilled nursing facilities as well as home health care and hospital inpatient care when the services qualify as necessary and reasonable. Most people that are U.S. citizens and have worked for at least 40 quarters in the country won’t pay any premiums for these benefits. A patient is not allowed to exceed the lifetime limit of 190 days of treatment from a specialty psychiatric hospital. Inpatient hospital facilities where care can be provided include:
- Acute care hospitals
- Mental health care
- Inpatient rehab centers
- Long-term care hospitals
- Critical access hospitals
- Inpatient care for an eligible research study
Part B CoverageThis part of Medicare is what covers your outpatient care. Additionally, Part B covers an alcohol misuse assessment once every year for adults who don’t quite meet an alcohol use disorder but still drinks. If this assessment shows your amount of alcohol use is of concern to your health and your provider declares it as so, you may be able to receive up to four counseling sessions per year. Medicare Part B will also cover partial hospitalization if a physician requires that as part of a patient’s care plan and has to consist of at least 20 hours a week of treatment. Partial hospitalization programs and services include:
- Individual and group therapy.
- Patient education.
- Occupational therapy.
- Administration of drugs for therapeutic reasons.
- Diagnostic services for mental health issues deemed as medically necessary.
- Family therapy.
- Activity therapies that are not chiefly recreational.
Medicare Part D CoveragePart D is the optional part of Medicare that covers retail prescription drugs. Medicare Part D may not cover every prescription drug, but it’s required for drug plans to cover anticonvulsants, antidepressants and antipsychotics used during mental health treatment. Additionally, Part D might cover medications used in treating substance use disorders for drugs such as drugs associated with opioid dependency. Every Part D beneficiary should check their provider’s drug formulary because each drug plan is different. A drug covered by one insurance provider covers may not be covered by another. According to the National Institute of Alcohol Abuse and Alcoholism, roughly 17 percent of adults ages 60 and over are affected by prescription drug and alcohol abuse. Substance abuse is especially dangerous to seniors because their bodies can’t metabolize these substances as well as younger people can, and they often experience an increase in brain sensitivity to these substances. If you or a loved one feel at risk of alcohol or substance abuse, take advantage of your Medicare coverage to get the help you need.
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