Does Medicare Cover Heroin or Drug Rehab?
If you’re concerned about heroin rehabilitation costs and looking for treatment, Medicare rehab coverage can help you get the care you need and begin your journey to recovery. While it may not cover the whole cost of drug rehab, Medicare can make it more affordable for you and your loved ones.
Medicare is a health insurance plan funded either federally or by the state to help you get access to necessary care. Medicare isn’t available to everyone. If you qualify, it can offer a lower-cost insurance option based on your age, disability status, and income.
Medicare has 4 parts that cover different types of addiction care and allow you to receive different types of services through insurance. To qualify for Medicare, you must be at least 65 years old or have a disability and you must meet certain income requirements. You can use Medicare to cover some or all of your drug rehab care.
A representative at American Addiction Centers (AAC) can help you find rehabs that accept Medicare. AAC works with Medicare to provide treatment for heroin and drug use. Our staff can help you understand your coverage and talk you through your next steps with Medicare.
What Will Medicare Cover?
Medicare covers medically necessary care based on 3 criteria, including federal and state laws and Medicare policies.1, Medicare coverage is based on 3 main factors It also depends on local companies that make coverage decisions and determine what qualifies as medically necessary care.
Medicare has 4 parts that cover different types of heroin rehabilitation treatment, including:
- Part A: Medicare Part A includes inpatient hospital care.2, Part A covers It covers inpatient rehab for up to 60 days without a co-pay. However, you will have a deductible. If you need inpatient care, you should ask your doctor about your coverage or call AAC and talk to a representative who can help you determine how much of your care Medicare will cover. The coverage may vary based on your situation.
- Part B: Medicare Part B covers outpatient care.3, Part B covers things like It includes up to 80% of treatment costs and includes therapy and necessary medications. Part B covers co-occurring mental health disorders and medically necessary services.
- Part C: Medicare Part C is also known as the Medicare Advantage Plan. It works through a Medicare-approved insurance plan, so you can get more coverage if you need additional benefits. In this case, because you have another insurance plan, you may end up paying more for premiums or have higher out-of-pocket expenses.
- Part D: Medicare Part D covers your prescriptions. If you need medications during addiction treatment, including detox, Part D will cover them.
Different parts cover different types of treatment under Medicare. Regardless, you can still access inpatient, outpatient, intensive outpatient programs (IOPs), and partial hospitalization programs (PHPs). Your coverage will depend on what you need. For example, if you need only outpatient care, you don’t have to worry about Part A, as it does not apply.
To find out which parts apply to you, call AAC or Medicare or check the Medicare website to see if heroin rehab is covered under your Medicare plan. 4, Forms, Help, & Resources If your treatment center is enrolled in Medicare, you may not have to pay anything out-of-pocket. 5, Your Costs in Original Medicare, first sentence Medicare covers opioid treatment with your doctor if you receive outpatient care, including mental health care. If you seek treatment with AAC and you have Medicare coverage, your treatment is most likely fully covered.
Does Medicare Cover Mental Health Care?
The people you work with at AAC know that you are dealing with an illness. They will not make you feel ashamed or embarrassed about seeking care for heroin addiction. Substance use disorder is classified as a mental health disorder and needs to be treated along with co-occurring mental health disorders.
Under the Affordable Care Act, health insurance must cover mental health care. In this case, Medicare Part B typically covers co-occurring disorder care, including mental health care, for inpatient and outpatient treatment and IOPs and PHPs. 6, Mental health and substance use disorder services This coverage also provides yearly depression screenings.
According to a 2019 study, 64.3% of people with opioid use disorder had a co-occurring mental health disorder.7, page 3, figure 1 graph With heroin addiction specifically, that number rose slightly to 64.9%, with 26.8% of those people having a serious mental illness.
More than half of people with substance use disorders have co-occurring mental health issues. This indicates an underlying problem. Not giving it the attention it requires means giving inadequate care that ignores the root of the problem.
Mental health care gives a person the additional support they need once they’ve gone through heroin detox. Treatment for substance use disorder does not end with detox. Many people need a reason to continue their recovery; offering mental health care beyond what they need for substance use disorder can give them that.
Without acknowledging mental health struggles, we leave out a significant part of a person’s story with addiction. Understanding co-occurring mental health disorders can treat a deeper issue, allowing the person to find resources they need for more than just abstinence.
At AAC, we always treat addiction as a mental health issue. We offer genuine, personalized help based on your needs. With mental health care, we help you create a support system so you have someone to turn to when you’re struggling.
How Long Does Medicare Cover Rehab?
Medicare covers 190 days of inpatient care over a person’s lifespan. Typically, with Original Medicare—as opposed to Medicare Advantage Plan (Part C)—you pay these amounts for inpatient heroin rehabilitation: 8, Your costs in Original Medicare
- Day 1-60: $1,364 deductible, unless you have already paid this deductible for previous inpatient care during that benefit period.
- Day 61-90: $341 copay per day.
- Day 91 onward: $682 copay per lifetime reserve day in each benefit period for up to 60 days over your lifetime allowance.
- Beyond your lifetime reserve: all costs out of pocket.
These costs vary with different plans, and they are not the same as what you pay for outpatient or PHP care. Always check with your rehab center, doctor, or Medicare to verify your benefits and understand the costs you are responsible for.
Some people tend to stay in heroin rehab treatment for longer for various reasons. Longer treatment has proven beneficial for many people.
According to the National Institute on Drug Abuse, detox doesn’t help much regarding long-term drug abuse.9, #10 on listLonger treatment times can give people a chance to see what resources are available to them. It can also help them understand that they are capable of recovery and that healing from addiction is often a lifelong process. It becomes easier not to rush the process or feel overwhelmed when you know you have enough time to work through your condition.
Treatment times of at least 6 months build trust and give people a stable support system of caregivers, therapists, doctors, and other professionals. They also have a chance to meet others facing a similar struggle and learn to work through it together, should they choose to do so.
Treatment looks different for everyone. For some, short-term inpatient or outpatient heroin rehab treatment works well. No matter what, your treatment should work with your personal needs.
At AAC, we tailor treatment to each person. We know no one’s addiction or recovery journey looks the same. We work with you to help you heal in the way that helps you most. For more information on your options with Medicare drug rehab, visit healthcare.gov.10
What are Medicare Eligibility Requirements?
Medicare is generally available to people who are:11, Who Is Eligible for Medicare
- Over 65
- Under 65 and have a disability
- Living with end-stage renal disease
In these cases, Medicare Parts A and B give you hospital insurance as well as medical insurance. You can also get Part A without a premium if you paid Medicare tax through your job for 10 years or more. You may not have to pay a premium if you get Social Security benefits or payments from the Railroad Retirement Board. The same applies if you are eligible to collect these payments but haven’t filed for them yet, or if you or your spouse had a government job that offered Medicare coverage.
If you’re under age 65, you can get Medicare without premiums if you have received Social Security or Railroad Retirement Board payments for at least 2 years. Kidney disease patients and kidney dialysis patients may also be able to get Medicare with no premiums.
No matter what, if you have Medicare, you have coverage for prescription drugs, which includes medication-assisted treatment for substance abuse. You can find your Medicare eligibility status online by using the eligibility tool.12
Medicare Sponsored Rehab
Use the Initial Enrollment Period if you want to sign up for Medicare. This period begins 3 months before you turn 65 and lasts for 3 months after you turn 65. You can sign up for Medicare online or contact the Social Security office to get your benefits.13, Note box
Changes to your plan are made during General Enrollment or Open Enrollment periods. When you want to use Medicare benefits for heroin rehab, you need to go to a Medicare-approved facility. Then, Medicare will cover your costs through the government.
Over 58 million people pay into Medicare.14, Medicare Trust Funds The money that pays for your care comes from Medicare Trust Funds through 2 U.S. Treasury accounts.
Hospital insurance is funded by employee payroll taxes, Social Security benefits, trust fund investments, and Medicare Part A premiums. The Supplementary Medical Insurance Trust Fund uses funds authorized by Congress. It also uses premiums from Medicare Part B and trust fund interest to pay for members’ care. Medicare approves who gets these funds.
Paying for treatment even after Medicare coverage can be difficult for many people. That’s why American Addiction Centers offers plans to finance your treatment. We can also help you talk with your relatives or friends to help you finance your treatment with your chosen heroin rehab center.
Let’s verify your coverage for treatment at an American Addiction Centers location. Your information is kept 100% confidential.
- Medicare.gov. What Part A covers.
- Medicare.gov. What Part A covers.
- Medicare.gov. What Part B covers.
- Medicare.gov. Forms, help & resources.
- Medicare.gov. Opioid use disorder treatment services.
- Medicare.gov. Mental health & substance use disorder treatment services.
- Substance Abuse and Mental Health Services Administration. Co-occurring substance use and mental disorders among adults with opioid use disorder.
- Medicare.gov. Inpatient rehabilitation care.
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide.
- Healthcare.gov. If you have Medicare.
- U.S. Department of Health and Human Services. Who is eligible for Medicare?
- Medicare.gov. Estimate my Medicare eligibility & premium.
- Medicare.gov. How can I sign up for Medicare & choose a plan?
- Medicare.gov. How Is Medicare funded?
Heroin Rehabilitation DirectorySelect a state to learn more about your treatment options.
- District Of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
Help for Heroin Addiction
Do you know someone suffering from heroin addiction? Help is available. To find out more, please choose the selection that applies to you or the person suffering from addiction: