Paying for Rehab with Medicaid and Medicare

In some cases, Medicaid and Medicare can help pay for detox, addiction medications and inpatient treatment centers. These programs may also be able to cover ongoing addiction treatment and mental health services.

What are Medicaid and Medicare?

16255177492_0cccffde96_zMedicaid and Medicare are federal- and state-funded health insurance programs. These insurance programs can provide free or low-cost drug and alcohol addiction treatment. Each program has different requirements for eligibility.

Medicare and Medicaid may cover part or all of your substance abuse treatment costs.

Every state has different rules for eligibility and treatment coverage. Rules for eligibility also change annually. If you were turned down for Medicaid or Medicare in the past, you could be eligible now.

Medicaid for Drug and Alcohol Rehab

Medicaid is a public insurance program for low-income families. Under the 2010 Affordable Care Act (ACA), also known as “Obamacare,” insurance providers (including Medicaid) must cover all basic aspects of drug and alcohol dependency recovery. While Medicaid covers substance abuse treatment, not all facilities accept Medicaid as a form of payment. To find a recovery provider that accepts Medicaid, get in touch with the Substance Abuse and Mental Health Services Administration (SAMHSA).

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Medicaid Eligibility by Income

To be eligible for Medicaid, applicants must be one of the following:

  • Over 65 years old
  • Under 19 years old
  • Pregnant
  • A parent
  • Within a specified income bracket

In some states, Medicaid covers all adults below a certain income level. Those who receive Supplemental Security Income are often automatically eligible for Medicaid.

The ACA requires people to earn less than 133 percent of the federal poverty level (FPL) to be eligible for Medicaid. A person living above the poverty level may still be eligible for government insurance if they fall in the right income bracket.

As of 2015, the table below explains the maximum income level allowed for Medicaid eligibility.

Medicaid Income Eligibility
Family SizeMax. Annual Income
1$15,654.10
2$21,186.90
3$27,121.50

Even if someone meets these income requirements, they may not be eligible for Medicaid. Each state has its own rules for Medicaid eligibility.

What Does Medicaid Cover?

Medicaid recipients don’t have co-payments for addiction treatment in most states. For states that charge co-payments, there is an out-of-pocket maximum set for Medicaid recipients.

Medicaid covers all or part of the following services:

  • Screenings
  • Intervention
  • Maintenance and craving medications
  • Family counseling
  • Inpatient care
  • Long-term residential treatment
  • Detox
  • Outpatient visits
  • Other mental health services
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Medicare for Drug and Alcohol Rehab

Medicare is available to anyone over 65 years old and those with disabilities. Medicare is available for a monthly premium, which is based on the recipient’s income. People who earn less pay lower premiums.

Medicare can cover the costs of inpatient and outpatient drug rehabilitation. It consists of four parts that cover different parts of addiction recovery programs.

The Four Parts of Medicare
Part AInsurance for Hospital Stays. Medicare Part A can help pay for inpatient rehabilitation. Part A covers up to 60 days in treatment without a co-insurance payment. People using Part A do have to pay a deductible. Medicare only covers 190 days of inpatient care for a person’s lifetime.
Part BMedical Insurance. Part B can cover outpatient care for addicted people. Medicare Part B covers up to 80 percent of these costs. Part B covers outpatient care, therapy, drugs administered via clinics and professional interventions. Part B also covers treatment for co-occurring disorders like depression.
Part CMedicare-approved Private Insurance. People who want more benefits under Medicare can opt for Part C. Out-of-pocket costs and coverage is different and may be more expensive.
Part DPrescription Insurance. Medicare Part D can help cover the costs of addiction medications. People in recovery often need medication to manage withdrawal symptoms and cravings. These medications increase the likelihood of staying sober.
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    Dual Eligibility

    A person can be eligible for both Medicaid and Medicare. If someone is eligible for both, they can apply benefits from each program to their treatment. If you are over 65 or disabled, you may be eligible for both programs.

    If you don’t have Medicaid or Medicare, contact a caseworker in your state. He or she can determine if you’re eligible for Medicaid or Medicare.

    If you are eligible, the caseworker will walk you through the application process.

    If you already have Medicaid or Medicare, you can find a drug or alcohol recovery facility by contacting SAMHSA.

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