Medicare: Questions About Rehab

Around 17 percent of adults 60 years old and older are affected by prescription drug and alcohol abuse, according to the National Institute of Alcohol Abuse and Alcoholism. Seniors are especially susceptible to the effects of substance abuse because their bodies aren’t able to metabolize these substances as easily and experience an increase in brain sensitivity. Medicare benefits don’t only exist for rehab following surgery or a traumatic accident. Yes, Medicare covers rehabilitation treatment for physical injuries, but Medicare also provides areas of coverage for drug and alcohol abuse rehabilitation. 

Does Medicare Part A Cover Rehab?

Medicare Part A will cover rehabilitation treatment received in a hospital setting if it is deemed “medically necessary” by a healthcare provider for substance abuse. Your Medicare Part A hospital benefits will cover up to 100 days after at least 3 days being in a hospital for inpatient rehab. Your benefit period for this will begin the moment you are admitted to the hospital. Part A covers inpatient care at other inpatient facilities such as skilled nursing facilities and home health care when a healthcare provider confirms the services as necessary and reasonable.

Inpatient hospital facilities a person can receive rehab treatment for substance abuse include:

  • Acute care hospitals
  • Mental health care
  • Inpatient care for an eligible research study
  • Long-term care hospitals
  • Inpatient rehab centers
  • Critical access hospitals

If a patient is receiving treatment from a specialty psychiatric hospital, they cannot exceed the lifetime limit of 190 days.

Does Medicare Part B Cover Rehab?

Unlike Part A, Part B covers outpatient care and services. Part B provides coverage for a yearly assessment for alcohol misuse for adults who don’t quite meet alcohol use disorder criteria but who still drink. If the results of the assessment show a level of alcohol use that is concerning to your provider, you may receive up to four face-to-face counseling sessions per year.

Partial hospitalization may also be covered under your Part B benefits if a physician requires that as part of your care plan. The plan of care is required to include at least 20 hours a week of treatment. Partial hospitalization programs and services include: 

  • Individual and group therapy
  • Occupational therapy
  • Patient education
  • Family therapy
  • Administration of drugs for therapeutic reasons
  • Diagnostic services for mental health issues deemed medically necessary
  • Activity therapies that are not chiefly recreational

Does Medicare Part D Cover Rehab Treatment?

Although Medicare Part D may not cover every prescription drug, the plans are required to cover at least one anticonvulsant, antidepressant and antipsychotic used for mental health treatment. For Medicare beneficiaries who suffer from substance abuse, a Medicare Part D plan might cover prescription drugs commonly used to help with substance abuse behaviors. For example, Part D plans have drugs associated with opioid dependence. 

Not every formulary is the same, so it’s important to check your formulary to confirm any drugs your healthcare provider includes in a treatment plan are covered. Exploring the different Part D plans available to you can make all the difference for your retirement savings. Different drugs may be included on one drug formulary and not the other, and in a lot of cases, drugs are listed on different tier levels with different insurance carriers.

When it comes to understanding Medicare and what it covers and doesn’t cover, it’s always recommended to contact your insurance provider to confirm. Check out your options to see what Medicare covers for rehabilitation if you or your partner on Medicare is experiencing drug or alcohol abuse