Before beginning any health-related process, it is essential to verify insurance benefits. If you are struggling with a substance abuse disorder, you may be wondering: how long does Medicare pay for rehab? The short answer is that it covers about 100 days of inpatient treatment and can cover more outpatient treatment time. Still, coverage varies according to different plans, as Part A, Part B, and Part D all cover various aspects of rehab care.
The level of care you seek can vary depending on the risk to your physical health and how frequently you use substances. Although choosing the best level of care for your needs is most important, the type of care will affect Medicare coverage.
This stage occurs as a result of physical deterioration, such as an overdose. It involves a hospital stay to combat symptoms of substance abuse. Medicare typically considers a three-day stay in acute hospitalization the signal that you need a higher level of care, so it is usually a prerequisite for Medicare coverage of inpatient rehab. Medicare only covers care in Medicare-approved facilities.
Screening, Brief Intervention, and Referral to Treatment
This process involves a medical assessment of the extent of your substance use via an interview regarding your habits and a physical evaluation. If you are determined to be potentially at risk of developing severe health issues, your provider may have a brief intervention to provide advice about your substance use. Also, your provider can refer you to a higher level of care at this point if it is necessary. Medicare Part B covers the screening process.
If you are referred to an inpatient rehab facility, you will live full-time in a residential treatment center. While you are there, you will receive individual and group counseling, medication management, medical monitoring, meals, education, occupational therapy, family support, and some recreational activities. This care level is covered by Medicare Plan A as long as a physician deems it medically necessary. According to a service-by-service basis, Medicare may cover this level of care, so contact your provider to ensure that you know exactly which benefits you will receive.
This level of care is an alternative to inpatient rehab that allows you to spend most of your day in treatment and go home in the evenings. It also involves individual and group counseling, medication management, family support, education, occupational therapy, and medical monitoring. You will only receive coverage for alternative or activity-based therapies if they are deemed necessary for your treatment. Medicare Part B covers this level of care if it is considered essential by a medical professional.
Some medications are necessary for the treatment of substance abuse disorders, especially during recovery from opioid addiction. If you need medication, Medicare Part D will cover it.
How Long Does Medicare Pay for Rehab?
Medicare covers inpatient rehab for up to 100 days per benefit period, which begins after three days of acute hospitalization and ends after 60 days with no hospitalization or intensive treatment. During each benefit period, you must pay a deductible of $1,364. Medicare offers complete coverage of the first 20 days of residential treatment, but you may have a copay for days 21-60. The copay for subsequent days until day 90 is $341, and after the ninetieth day, there is a copay of $682. You can continue treatment with a copay of $682 for a reserve period of up to 60 days if you receive permission for an extension. After the expiration of an approved extension or 100 days without approval for an extension, Medicare no longer covers rehab. Still, you can usually begin another benefit period three days after the end of a period.
Medicare will cover your screening, followed by partial hospitalization. The specifics of coverage for partial hospitalization depend on the provider, but to meet the coverage requirements, the program must last a minimum of 20 hours per week. Since each plan varies slightly, contact your provider for more specific information. Part B may also cover an annual alcohol screening if necessary, and you don’t meet the criteria for inpatient or partial hospitalization rehab.
There is no time specified for how long Medicare covers Part D medications, but the medications must require a prescription to qualify for coverage.
“How long does Medicare pay for rehab?” is a difficult question to answer, but in summary, you can receive a fair amount of coverage for up to 100 days at a Medicare-approved facility if need be. You need to have a Medicare plan involving at least Plan A and Plan B, and preferably Plan D, to receive comprehensive coverage of screenings, inpatient, partial hospitalization, and medication if needed. Treatment is within your reach with Medicare.