Medicare covers an annual screening for alcohol misuse. If the screening shows you may be misusing alcohol, Medicare will also pay for a series of short counseling sessions to help you avoid a bigger drinking problem. Also, Medicare covers more in-depth counseling and alcohol treatment programs.
Does Medicare Cover Alcohol Misuse Screening?
Part B pays for an annual screening for alcohol misuse. Your doctor screens as 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 may not concern your doctor. But they could indicate alcohol misuse or dependence.
The National Institute on Alcohol Abuse and Alcoholism defines alcohol misuse as harmful drinking:
- 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; family or employment, but isn’t alcohol dependent.
To be diagnosed with alcohol dependence, you must have 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 don’t meet the medical criteria for alcohol dependence, Part B covers alcohol counseling. You can get up to four brief counseling sessions a year. Both screening and counseling are preventive services.
Will Medicare Cover Alcohol Rehab?
As part of its substance abuse coverage, Medicare covers both inpatient and outpatient alcohol rehab if it’s medically necessary. You must receive treatment in a Medicare-approved treatment facility.
Inpatient treatment usually lasts from one to three months, and it may occur in either a hospital or a rehab center. If you get inpatient treatment, you’ll pay Part A costs.
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 Part B. Also, partial hospitalization is where you report to a hospital or mental health center for intensive treatment, but don’t stay overnight. Part B covers the necessary partial hospitalization.
If Medicare is your only insurance, alcohol treatment can be costly. But a Medigap plan can pay the Part A deductible and extend the number of days Medicare pays for hospitalization.
What Does Alcohol Misuse Treatment Cost With Medicare?
If your annual screening suggests alcohol misuse, you can get four counseling sessions free of charge. If you need additional counseling for alcohol misuse or related mental health issues, Part B may cover individual and group psychotherapy.
What is the Medicare Reimbursement for Alcohol Misuse Treatment?
If for some reason, you have to 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 your doctor will accept Medicare’s rate as full payment.
Why Did Medicare Deny Alcohol Rehab or Treatment?
Medicare may deny your claim if your treatment isn’t necessary or if you go to a doctor that doesn’t accept Medicare.
If you have a Medigap plan, those plans sometimes deny claims based on pre-existing conditions. If you were diagnosed with a substance abuse disorder before enrolling, your plan may exclude coverage.
Always read the fine print on pre-existing conditions before signing up for insurance. Finally, some Advantage plans can deny claims if your doctor isn’t in your plan’s network.
How to Get Medicare Coverage for Alcohol & Substance Abuse Treatment
A Medigap plan can help lower your 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 quote. Just give us a call at the number above or fill out our online form.