Do Alcohol Detox Centers Accept Medicare?

Alcohol addiction and substance abuse can weave their way into many different groups of people for reasons of coping, especially in older adults and people struggling with a disability.

The National Institute on Aging notes that many people may develop a harmful reliance on alcohol in their later years, and there are many reasons why seniors may turn to alcohol as a form of self-medication. It could be to cope with recent major life changes, like the death of a spouse or family member, coping with retirement, moving to a new home, or dealing with health issues. “These kinds of changes can cause loneliness, boredom, anxiety or depression,” notes the institute. “In fact, depression in older adults often aligns with drinking too much.”

Why Do People Drink Alcohol?

Individuals with disabilities may drink for similar reasons. “The complex interplay of social, economic, and health factors associated with disability are also risk factors for substance use, unhealthy use, and addiction,” notes a study published by Brandeis University.

It’s never too late to address a drinking problem. Addiction treatment is the first step in conquering alcohol abuse; however, the cost of rehab may be overwhelming if you’re on a fixed income. Fortunately, many people over the age of 65, or those younger than 65 with qualifying disabilities, are covered by Medicare.

But the question remains: can you find an alcohol detox that accepts Medicare for yourself or if you’re looking into treatment for a family member?

What Is Medicare?

Medicare is a national federal program that primarily subsidizes health insurance for people aged 65 and older, though it can also cover younger people with certain disabilities or qualifying medical conditions, such as amyotrophic lateral sclerosis, aka Lou Gehrig’s disease, plus individuals in the later stages of renal disease needing dialysis.

There are four components to Medicare coverage, each with its own rules and regulations for healthcare services depending on your medical needs and the type of Medicare plan you have. Original Medicare is divided into Parts A and B:

• Medicare Part A is insurance for hospital-based expenses. It helps cover inpatient hospital care (including hospital stays), skilled nursing facilities and pays for the cost of some select home healthcare and hospice care services. Coverage is customary for anyone receiving Social Security benefits.
• Medicare Part B is insurance that covers medical expenses — doctors’ visits and many preventive services, outpatient care, and home health services, plus the cost of medical equipment and mental health services (up to four individual and group therapy sessions). Part B also covers Intensive Outpatient Treatment, or IOD, and an annual alcohol misuse screening, free of charge.

The remaining two parts of Medicare cover expenses for additional medical needs:

• Medicare Part C is also known as the Medicare Advantage Plan. It covers all the same benefits and services under Medicare Parts A and B but bundles coverage for prescription medication and vision, dental, and hearing benefits. Part C — “Medicare-managed care” — is a bit different from the other three Medicare treatment plans because services are offered through private insurance providers.
• Medicare Part D is available to anyone enrolled in Parts A or B and strictly covers the costs of inpatient/outpatient prescription drugs for alcohol abuse disorder and withdrawal (such as naltrexone, acamprosate, and disulfiram) as part of a Medication Assisted Treatment (MAT)

Does Medicare Cover Alcohol Detox?

The good news is that, yes, Medicare for alcohol treatment covers alcohol detox, the first step toward flushing alcohol from one’s system and managing withdrawal symptoms. Depending on the nature of the treatment, your care should be Medicare accepted under parts A and B, and even Part D.

Medicare Part A provides insurance coverage if you require inpatient detox care. That means that if you need hospitalization or a stay in a residential treatment program for alcohol abuse disorder, Medicare will help cover the costs.

Remember that if you or a loved one is looking for a treatment program starting with alcohol detox that accepts Medicare, the plan will only cover inpatient/outpatient treatment as long as it is deemed medically necessary.

Is All Addiction Treatment Covered by Medicare?

After a detox phase, more is covered by Medicare for alcohol abuse disorder. Medicare Part B covers outpatient alcohol abuse disorder care, where you receive treatment during the day but can return home in the evenings — ideal when you’re transitioning out of a residential program and are in a stage of recovery not requiring 24/7 care. Aftercare (treatment following an inpatient hospital stay or outpatient recovery) is also covered.

However, keep in mind that while using Medicare for addiction treatment is very comprehensive, there are some limitations and exceptions.

Original Medicare — Parts A and B — covers 80% of your approved benefits. You’ll need to pay the remaining 20% copay, so budget for these costs after receiving an estimate for care.

The duration of alcohol rehab can vary from person to person, but bear in mind that Original Medicare also limits inpatient residential care at a Medicare addiction treatment center to a maximum of 190 days. Additional time spent in rehab centers becomes your out-of-pocket responsibility. Under Medicare Part A, private amenities, such as nursing or rooms, are also not covered.

Medicare Part B does not cover the costs of services attached to inpatient care or medical equipment not necessary for treatment. Not every Medicare drug is covered under Medicare Advantage or Part D, but Medicare is required to include antidepressants, antipsychotics, and anticonvulsants.