Does Medicare Cover Alcohol Rehab?

You may be wondering: Does Medicare cover alcohol rehab? Fortunately, Medicare coverage for alcohol abuse and rehab is available when necessary.

The federal healthcare program will cover essential services, including an annual alcohol misuse screening and counseling if required.

If you believe these programs may help you on the road to recovery, read below to learn more about alcohol misuse coverage by Medicare.

Medicare Alcohol Misuse Screening and Counseling

Once per year, Medicare Part B covers a screening for alcohol misuse. This screening is typically part of your Annual Wellness Visit. It consists of questions about alcohol use.

Your doctor may ask the questions or give you a form to fill out. Your answers to this screening survey will indicate whether you have an alcohol dependency that could lead to alcohol misuse and abuse.  

A few signs of alcohol abuse or misuse include:

• Having more than seven drinks a week for women or fourteen drinks a week for men
• Having more than three drinks a day for women or four drinks a day for men
• A drinking pattern that causes harm to family or employment but is not alcohol dependent.

For a diagnosis of alcohol dependence, you must check one of the boxes above and exhibit at least three other specific alcohol-related behaviors, such as tolerance, withdrawal symptoms, and an inability to cut down or quit.

If the screening indicates you’re misusing alcohol but you do not meet the medical criteria for alcohol dependence, Medicare Part B covers alcohol counseling. You can get up to four brief counseling sessions a year.

Medicare considers alcohol screening and counseling preventive services, so they receive coverage.

Medicare Coverage for Alcohol Rehab

As part of its substance abuse coverage, Medicare covers alcohol rehab if your physician deems it medically necessary. However, you must receive treatment in a Medicare-approved treatment facility.

Inpatient alcohol rehab and treatment usually lasts from one to three months, depending on the severity of your dependency. It may occur in either a hospital or a rehab center.

If you have inpatient treatment at a specialty psychiatric hospital, you should know that Medicare will only pay for 190 days of treatment at a psychiatric hospital in your lifetime.

Outpatient rehab falls under Medicare Part B. Also, Medicare Part B covers partial hospitalization. This is where you report to a hospital or mental health center for intensive treatment but do not stay overnight.

Does Medicare Cover Inpatient Alcohol Rehab?

Original Medicare (Part A and Part B) will cover inpatient alcohol rehab if medically necessary. If you receive inpatient treatment, you will be responsible for paying the same Medicare Part A costs in any other circumstance. So, inpatient alcohol rehab can become expensive.

If you are considering alcohol rehab, it is essential also to explore Medicare Supplement (Medigap) plans. These policies help cover your out-of-pocket costs. This way, you can receive the necessary coverage without a high hospital bill.

Does Medicare Cover Alcohol Detox?

Alcohol rehab and alcohol detox are not the same treatment. However, Medicare will cover both services when medically necessary.

Alcohol detox is typically a seven-day inpatient care service that provides one-on-one and group intervention, therapy, and planning sessions.

It is essential to find a detox facility that accepts Original Medicare. Many detox facilities do not take a wide variety of insurance coverages and are almost exclusively self-pay. Therefore, you must verify whether they accept Medicare before your treatment.

What Does Alcohol Misuse Treatment Cost on Medicare?

If your annual screening results in an alcohol misuse diagnosis, you can receive up to four counseling sessions free of charge. If you need additional counseling for alcohol misuse or related mental health issues, Medicare Part B may cover individual and group psychotherapy.

If, for some reason, you must pay for your counseling sessions, you can file a claim for reimbursement. When you seek alcohol misuse counseling from a psychologist, be sure they accept Medicare. Your doctor will bill Medicare for you and accept Medicare’s rate as full payment.

If you require rehab, you may be responsible for the Medicare Part B deductible, Medicare Part A copayments, and coinsurance. So, additional coverage may be necessary when receiving alcohol rehab services.

Medicare Supplement plans or some Medicare Advantage plans may be able to help cover these costs. 

Why Did Medicare Deny Alcohol Rehab or Treatment?

Medicare may deny your claim if your treatment is unnecessary or if you go to a doctor who does not accept Medicare. If you were diagnosed with a substance abuse disorder before enrolling in a Medicare Supplement plan, your plan might exclude coverage for a specific timeframe. However, this is carrier specific and will not happen with all Medicare Supplement plans.

Not all Medicare Supplement plans have pre-existing condition limitations. Thus, you must always read the fine print on pre-existing conditions before enrolling in a plan. Finally, some Medicare Advantage plans will deny claims if your doctor is not in your plan’s network or if the plan does not cover the service you may need.

However, once a claim is denied, you can complete an appeal for Medicare to cover the service. This process can take a few weeks and is not always guaranteed.

Medicare Alcohol Rehab FAQs

How to Get Medicare Coverage for Alcohol Rehab

The best way to help end alcohol misuse and abuse is by seeking treatment. However, treatment may become costly without the right plan in place. A Medicare Supplement policy can help lower out-of-pocket costs, making substance abuse treatment affordable when you need it most.

At MedicareFAQ, we can guide you through choosing a plan, beginning with a free, no-obligation plan comparison. Just give us a call at the number above or fill out our online form.

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