Dear Marci,
I’m helping my father set up his treatment for substance use disorder. Does Medicare cover this kind of care?
-Saul (Arlington, VA)
Dear Saul,
Yes, Medicare should cover alcoholism and substance use disorder treatment for your father if:
His provider states that the services are medically necessary
He receives services from a Medicare-approved provider or facility
And, his provider sets up his plan of care
Medicare covers treatment in both inpatient and outpatient settings. Here are just a few examples of the services that Medicare covers:
Psychotherapy
Opioid treatment program (OTP) services
Patient education regarding diagnosis and treatment
Post-hospitalization follow-up
Part A should cover his care if he is hospitalized and needs substance use disorder treatment. If he is in an inpatient psychiatric hospital, keep in mind that Medicare only covers a total of 190 lifetime days. Once this limit has been reached, though, Medicare may cover care at a general hospital. A plan’s cost-sharing rules for an inpatient hospital stay should apply.
Part B should cover outpatient substance use disorder care he receives from a clinic, hospital outpatient department, or opioid treatment program. Original Medicare covers these services at 80% of the Medicare-approved amount. As long as he receives the service from a participating provider, he will pay a 20% coinsurance after meeting his Part B deductible. Visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to find participating providers. If he is enrolled in a Medicare Advantage Plan, contact his plan for information about costs, coverage, and in-network providers for substance use disorder treatment.
I hope this information is helpful to you and your father. Wishing him well on his recovery.
-Marci