Medicare, just like all health insurance policies offered on the open exchanges since the implementation of the Affordable Care Act, does cover the cost of drug rehab. Distinct from treatment services covered for the treatment of alcohol abuse or alcoholism, the Centers for Medicare and Medicaid Services acknowledge that different services may be necessary to treat patients who are struggling with drug abuse or addiction based on:
- The drug (or drugs) of choice
- Duration of use
- Underlying mental health disorder(s) or symptoms
- Underlying medical conditions
The First Line of Attack
Medicare, like many health insurance coverage policies, usually requires patients who are seeking drug rehab to first undergo outpatient treatment. Even if detox is necessary, they often require patients to utilize a combination of treatment services on an outpatient basis unless it can be demonstrated that more extensive, round-the-clock coverage is medically needed. No matter what services are ultimately covered, they must be “reasonable and necessary for treatment of the individual’s condition.” Covered services include medication therapy, psychotherapy, and patient education.
Inpatient Care Is an Option
Though outpatient treatment services may be the first recommendation of Medicare, if the doctor can demonstrate that inpatient drug rehab is medically necessary for detox and/or therapeutic intervention. In most cases, the increased risk of relapse without constant care and supervision does not constitute medical necessity. However, issues such as co-occurring mental health disorders, like depression, schizophrenia, or serious mood disorders, may fall in this category as they increase the risk of complications during detox. Similarly, having been unsuccessful in outpatient addiction treatment in the past may indicate the need for more intensive treatment.
Medicare also covers outpatient treatment services if they are necessary for treatment on an ongoing basis after drug rehab. Like inpatient care, a medical doctor must recommend this and medical need may need to be demonstrated. Psychotherapy, drug maintenance and other services may be included on a case-by-case basis.
If the patient is concerned about embarking on a treatment program that may not ultimately be covered by Medicare, securing authorization for coverage prior to starting treatment is recommended. Should Medicare refuse to cover all or part of the services requested, the patient and his or her family are free to determine if they would like to take on the cost and pay out of pocket.
Other Payment Options
If the patient wants services or treatment at a program that is not covered by Medicare, or if Medicare takes too long to work out the details and the patient would like to begin treatment right away, there are other payment options available. These include:
- Supplemental insurance. There is a range of options available, including health savings accounts, that can be useful in this instance.
- Savings. Even retirement savings or a college fund may be a possible source of funds for covering the cost of treatment.
- Borrowing. Close friends and family may be interested in investing in the future of the addicted patient.
- Financing. A range of financing options is available with different payment plans.
Dealing with Insurance
Government-backed insurance may not be easier to deal with than a private health insurance company, but putting in the time to call with questions and ask for help when it comes to figuring out how to pay for drug rehab can more than pay for itself. Don’t wait to seek assistance if your addicted loved one is ready to enroll in treatment for a chronic drug abuse or addiction problem.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.