Published by: Medicare Rights Center
Medicare should cover alcoholism and substance use disorder treatment for a parent if:
- Their provider states that their services are medically necessary
- They receive services from a Medicare-approved provider or facility
- And, their provider sets up their 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 their care if they are hospitalized and needs substance use disorder treatment. If they are in an inpatient psychiatric hospital, keep in mind that Medicare only covers a total of 190 lifetime days. Once their 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 they receive 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 they receive the service from a participating provider, they will pay a 20% coinsurance after meeting their Part B deductible. Visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to find participating providers. If they are enrolled in a Medicare Advantage Plan, contact their plan for information about costs, coverage, and in-network providers for substance use disorder treatment.