Does Medicare Cover Alcohol Treatment?

Alcohol abuse is a big concern in the US, so alcohol treatment is readily available in every state to assist addicts with getting their problem under control. These programs educate alcoholics about their substance abuse and help those suffering from alcohol addiction to stop drinking by making important life changes. Alcohol treatment at most facilities will include counseling sessions both in a group and individual setting. There are also medications that can be administered that aid in getting an alcohol addiction under control during detox and treatment.

Of course, not all health insurance policies are the same, and those who need to attend alcohol treatment will have to contact their insurance provider directly to find out specifically if their policy covers some or all of the cost. One of the many questions that come up in this arena is whether or not Medicare will cover alcohol treatment. Whether or outpatient or inpatient alcohol treatment programs, the answer is Yes. Medicare does provide coverage for alcohol treatment but there are stipulations. First, you must attend an alcohol treatment center that is part of Medicare’s network of providers. Second, your primary doctor has to deem your alcohol treatment to be “medically necessary”. Additionally, Medicare requires that your own doctor has a hand in arranging your personal treatment plan.

As it pertains to inpatient alcohol treatment, Medicare Part A will cover a portion of your stay if you become hospitalized for alcohol abuse. In this circumstance, all of your out-of-pocket expenses for the alcohol treatment center would be the same as if you were hospitalized for any other health issue. As it pertains to outpatient alcohol treatment programs, Medicare Part B will cover a portion of your alcohol treatment from a center approved in the Medicare network that has outpatient alcohol treatment programs. Medicare Part B covers 55% of the amount approved that goes towards mental health services. Any costs above and beyond the 55% will be out of pocket or if you have supplemental health insurance, you may be able to receive additional coverage.

As far as Medicare and alcohol treatment, the types of services that can be covered include:

•   Patient substance abuse education
•   Psychotherapy for Dual Diagnosis as deemed necessary
•   Aftercare services (such as counseling and sober living)
•   Prescription drugs or injections administered in a doctor’s
office

If you are looking to use your Medicare for alcohol treatment, you will find that there are many quality alcohol treatment centers to choose from that are “in network”. You have to remember to keep your primary care physician at the forefront of your care for substance abuse in order to maximize coverage, as you will need a referral to get that approval for coverage.

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