Does Medicare Cover Drug Rehab?

Medicare typically covers drug rehab and alcohol rehabilitation in inpatient and outpatient settings.

If Medicare covers your substance abuse rehab, you may face some out-of-pocket costs such as Medicare deductibles, coinsurance and more.

A Medicare Supplement (Medigap) plan can help cover some of your drug rehab Medicare costs.

Medicare does cover some drug and alcohol rehab services.

When Does Medicare Pay for Drug Rehabilitation?

Original Medicare (Medicare Part A and Part B) pays for drug rehabilitation if:

• Your doctor deems it medically necessary

• The rehab provider and facility participate in Medicare

• Your doctor develops a treatment plan for you

Medicare Part A Covers Inpatient Drug Rehab Treatment

Medicare Part A helps cover your care if you are hospitalized for substance abuse rehab treatment.

However, you are still responsible for your Medicare Part A out-of-pocket costs which may include:

• Part A deductible
  In 2024, the Medicare Part A deductible is $1,632 per benefit period.

• Part A coinsurance
  The first 60 days that you spend in a hospital do not require you to pay a coinsurance fee. After 60 days, you are responsible to pay the following:

  • Days 61-90: $408 coinsurance per day of each benefit period in 2024

  • Days 91 and beyond: $816 coinsurance in 2024 per each "lifetime reserve day" after day 90 for each benefit period (you have up to 60 lifetime reserve days over your lifetime)

  • Beyond lifetime reserve days: all costs

Medicare only covers 190 days spent in a psychiatric hospital over your entire lifetime.

Medicare Part B Covers Outpatient Drug Rehab Treatment

Medicare Part B helps pay for drug treatment received at a clinic or doctor's office.

Covered rehab services typically include:

• An assessment to determine the severity of your substance abuse

• Psychotherapy

• Patient education to help you better understand your diagnosis and treatment options

Typically, Medicare covers 80% of the Medicare-approved amount for a service, and you pay the remaining 20% (once your Part B deductible is met).

In 2022, the Medicare Part B deductible is $240 per year.

Methadone and Other Prescription Drugs

Prescription drugs are not covered by Medicare Part A or Part B. For prescription drug coverage, you may enroll in a Medicare Part D prescription drug plan, which are sold by private insurance companies.

Currently, methadone that is used in outpatient rehab treatment is not typically covered by Medicare, but it may be covered for hospital inpatients in some cases.

Find Medicare Supplement Plans That Help Cover Your Rehab Costs

If you receive alcohol and/or drug rehab treatment that is covered by Medicare, a Medicare Supplement Insurance (Medigap) plan can help cover some of the out-of-pocket costs you will typically face.

For example, each of the 10 standardized Medigap plans that are available in most states provide at least partial coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered outpatient drug rehab.

Learn more about common procedures that medicare covers.

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.