Can I Use Medicaid and Medicare to Pay for Rehab?

What are Medicaid and Medicare?

Medicaid and Medicare are government-funded health insurance programs designed to help certain populations get necessary healthcare. There are programs that are funded by the state and the federal government.

People who are eligible for Medicaid or Medicare services are entitled to free or low-cost medical care. This includes both drug and alcohol addiction treatment.

Some people qualify for both Medicare and Medicaid. If you or a loved one needs addiction treatment, consider contacting an addiction treatment specialist who can evaluate your options. Especially if you don’t know if you qualify for both.

Can I Use Medicaid to Pay for Rehab?

Yes. People who qualify for Medicaid or Medi-cal receive financial support for alcohol and drug use treatment. The amount someone receives varies from state to state.

Under the Mental Health Parity and Addiction Equity Act, anyone with health coverage is entitled to support for substance use disorders. This includes anyone who qualifies for Medicaid.

This legislation prohibits any insurance provider from discriminating against a patient’s needs for behavioral health treatment. Under the law, Medicaid must provide drug abuse treatment similar to other medical conditions.

Sponsored

Online Therapy Can Help

Over 3 million people use BetterHelp. Their services are:

• Professional and effective
• Affordable and convenient
• Personalized and discreet
• Easy to start

Find a Therapist

Answer a few questions to get started

What Does Medicaid Cover?

Medicaid services cover all or part of many addiction treatment programs. Beyond basic treatment services, Medicaid also covers mental health services.

Programs covered by Medicaid include:

• Screenings
• Intervention
• Maintenance and relapse prevention
• Addiction medications
• Family counseling
• Inpatient care
• Medical detox
• Long-term residential treatment
• Outpatient care
• Other mental health services

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) expands addiction recovery treatment options to include:

• Counseling
• MAT
• Therapy
• Peer Support
• Social Services
• Other relevant SUD treatment

Keep in mind the federal Medicaid program does not charge co-payments. State programs can, but they regulate out-of-pocket limits. 

Who is Eligible for Medicaid?

Medicaid qualifications are generally based on financial need, medical necessity, and age. To be eligible for Medicaid, you must meet at least one of the following qualifications:

• Under 19 or over 65 years old
• Pregnant
• A parent
• Within a specific income bracket

Some states automatically provide Medicaid coverage to all residents under a certain income level. Anyone receiving Supplemental Security Income (SSI) automatically qualifies for Medicaid coverage.

Under the Affordable Care Act (ACA), someone must earn less than 133% above the federal poverty level to qualify for federal Medicaid coverage. States with expanded Medicaid benefits under the ACA offer Medicaid coverage to people earning 138 percent above the poverty level.

Sponsored

Get Professional Help

BetterHelp can connect you to an addiction and mental health counselor.

Find a Therapist

Answer a few questions to get started

Can I Use Medicare to Pay for Rehab?

Yes, you can. A doctor must deem inpatient addiction rehabilitation medically necessary to qualify for coverage. 

Medicare recipients must also receive care from a Medicare-approved rehab facility. In some cases, this requires a three-day hospital stay before admission. 

What Does Medicare Cover?

Medicare pays for various rehab services and substance abuse treatment programs. These include:

• Inpatient rehabilitation
• Outpatient rehabilitation
• Medications
• Counseling
• Therapy

Although Medicare covers inpatient and outpatient treatment, it doesn’t cover intensive outpatient programs.

Who is Eligible for Medicare?

Generally, Medicare is an age-based program for people 65 or older. You may be able to get Medicaid earlier if you have:

• End-stage renal disease or Permanent kidney failure
• Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease
• Social Security disability benefits for at least 24 months
• Received a disability pension from the Railroad Retirement Board and met certain conditions

The cost of Medicare coverage is based on the recipient’s income. 

Are MAT Medications Covered by Medicaid & Medicare?

Medicaid and Medicare cover the cost of drug rehab and addiction treatment. The federal programs were expanded in 2020 to increase access to medication-assisted treatment (MAT) for people with opioid addiction.

State programs also provide Medicaid coverage for certain drugs. Some of the medications covered by Medicaid and Medicare include:

• Methadone: An opioid agonist that reduces withdrawal symptoms and cravings
• Buprenorphine: A partial opioid agonist that is less potent than methadone but still helps with withdrawal symptoms and drug cravings
• Naltrexone: An opioid antagonist that blocks the euphoric effects of opioid drugs from occurring

Can I Use Other Insurance?

In some cases, yes, you can combine Medicare and/or Medicaid with private insurance coverage. Some people automatically qualify for Medicare Parts A & B, covering hospital and medical insurance respectively. This can happen when you receive Social Security or Railroad Retirement Board benefits for more than four months before your 65th birthday.

You can enroll in a Medicare supplement plan or Medicare Advantage Plan for help with the cost of prescription medication. The same applies to people under 65 who receive Social Security disability benefits or Railroad Retirement Board benefits for at least two years.

If you don’t automatically qualify for Medicare, you must apply for benefits during the seven-month enrolment period. People who fail to apply during this window risk a lapse in coverage and/or penalties.

Things to Keep in Mind When Applying for Other Insurances

The General Enrollment Period for Medicare begins from January 1^st to March 31^st every year. The benefit period of coverage begins in July of the year you apply.

Private insurers within the ACA Marketplace cannot provide insurance to people with Medicare. Once you sign up for Medicare, you can’t use the Marketplace for private insurance unless you’re paying a premium for Medicare Part A. You’ll have to drop Medicare for the Marketplace plan.

How to Determine Primary and Secondary Plans

Coordination of benefits rules determines which plan is primary and which is secondary when someone has both Medicare and non-Marketplace private insurance coverage. Typically the primary plan pays claims first.

Any cost leftover after primary coverage pays is covered in part or in full by the secondary coverage. For example, Medicare coverage is secondary for someone over 65 who has chosen to continue working and also has employer-provided insurance coverage from an employer with 20 or more employees. 

Sponsored

Phone, Video, or Live-Chat Support

BetterHelp provides therapy in a way that works for YOU. Fill out the questionnaire, get matched, begin therapy.

Get Started

Answer a few questions to get started

What if I Don’t Have Insurance?

If you’re not eligible for Medicaid or Medicare, there are alternatives for financing rehab services and addiction treatment. However, you’re supposed to have insurance or risk being fined.

Fortunately, recent legislative changes have made addiction treatment more affordable and accessible than ever. Consider reaching out to addiction specialists to learn more about addiction rehab and affordable options.

Alternatives for Medicaid or Medicare include:

1. Financing

Some facilities offer financing options, so patients don’t need to pay for the full amount of a program upfront. In most cases, the initial payment isn’t due until after completing treatment. There might also be a grace period of a few months.

2. Scholarships and Grants

Some programs offer or accept scholarships or grant money to pay for treatment. One of the most commonly used grants available is from the Substance Abuse and Mental Health Services Administration (SAMHSA).

3. Sliding Scale

Some facilities base their fees on the financial ability of patients. This means someone earning less pays less for care than someone with a higher income.

4. Subsidized Coverage

The Affordable Care Act offers insurance coverage to people who can’t afford private insurance and don’t qualify for Medicare or Medicaid.

5. Private Funding

Some people choose to use their savings or ask friends or family for financial support to attend rehab. You might also consider a “Go Fund Me” or other crowd-funding option to help a loved one or yourself pay for rehab.

What is the Difference Between Medicaid and Medicare?

Medicaid is a disability and income-based program. On the other hand, Medicare is an age-based program.

Medicaid provides health coverage if you have a very low income to help cover medical. Medicare provides health insurance for people who are 65 or older. However, people under 65 with certain disabilities or conditions can qualify for Medicare.

Medicaid also offers benefits that Medicare doesn’t normally cover. This includes support from a skilled nursing facility and other personal services.

Summary

Medicare and Medicaid offer treatment coverage for various medical needs. Both are government-funded programs designed to provide necessary healthcare.

Both Medicaid and Medicare cover addiction treatment and other rehabilitation services. You can also receive care at an inpatient rehabilitation facility with both insurance programs.

However, there are certain qualifications you have to meet to be eligible for either insurance. Contact your doctor to see if you are eligible for Medicare, Medicaid, or both.

Sponsored

Get matched with an affordable mental health counselor

Find a Therapist

Answer a few questions to get started