paying for treatment with Medicare or Medicaid

Paying for Treatment with Medicare or Medicaid

What are Medicare and Medicaid?

Depending on the type of addiction treatment program you’ve selected, many of them offer the option to use government funded healthcare programs.

Inn fact, one of the most commonly used methods for paying for drug and alcohol rehab  is Medicaid or Medicare, both of which are are federal or 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, and 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.

Paying for treatment with Medicare or Medicaid can save you or you family tens of thousands of dollars, but not all treatment centers accept this insurance and not all patients will qualify. There are many addiction treatment centers in Southern California so if you’re considering coming here, you should talk to an Admissions Director to discuss your options.

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). Despite the switch away from Obamacare, most insurance programs still provide addiction treatment coverage. Paying for treatment with Medicare or Medicaid is a good way to go for those who qualify.

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

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.

While there are other options to pay for treatment (personal loans, credit cards, private health insurance, paying for treatment with Medicare or Medicaid is another option for those who are struggling to cover the costs.

Don’t Expect the Waldorf Astoria

It’s important to remember that for those paying for treatment with Medicare or Medicaid, you should not expect to get treatment as some luxurious, beachfront mansion. Accommodations will definitely be more modest, but as we tell unrealistic patients, Rehab is not a vacation – it’s a treatment program.

Ok, so you won’t have 1500 count Egyptian cotton sheets, but what you will have is a group of dedicated professionals who are absolutely committed to your success. The addiction treatment professionals don’t care if you’re paying for treatment with Medicare or Medicaid – they want you to succeed.  Your success is their success, because the more success stories they have, the more patients they can servce. They absolutely have skin in the game.

With that said, given the two pictures below, guess which one Medicare or Medicaid is paying for?

A $20,000 Per Month Room at a Celebrity Rehab

A $2,000 Per Month Room at a Typical Rehab

 

Paying for addiction treatment with Medicare or Medicaid means that taxpayers are footing the bill. As such, no reasonable person can expect luxury accommodations, but that’s not the point. Addiction recovery is almost a life or death matter.

Where you get treatment doesn’t matter so long as it is a place that provides quality care and since Rehab and Residential Treatment centers are regulated, it’s in everyone’s best interests to ensure that patients succeed.

 

 

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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