Does Medicare Cover Addiction Recovery Services?

Medicare covers treatment for alcoholism and substance use disorders in both inpatient and outpatient settings if:

  • Your provider states that the services are medically necessary
  • You receive services from a Medicare-approved provider or facility
  • And, your provider sets up your plan of care

Covered services include but are not limited to:

  • Patient education regarding diagnosis and treatment
  • Psychotherapy
  • Post-hospitalization follow-up
  • Opioid treatment program (OTP) services (see Does Medicare Cover Opioid Treatment Programs?)
    • FDA-approved opioid treatment medications (methadone, buprenorphine, naltrexone)
      • Dispensing and administering drug, if applicable
    • Substance use counseling
    • Individual and group therapy
    • Toxicology testing
    • Intake activities and periodic assessments
  • Prescription drugs administered during a hospital stay or injected at a doctor’s office
    • Methadone may be covered in inpatient hospital settings
  • Outpatient prescription drugs covered by Part D
    • Part D plans must cover medically necessary drugs to treat substance use disorders
      • Part D plans cannot cover outpatient methadone or similarly administered medications to treat substance use disorders, but they can cover methadone for other conditions, such as pain. (Note: OTPs can provide methadone for substance use disorder treatment.)
      • Structured Assessment and Brief Intervention (SBIRT) services provided in a doctor’s office or outpatient hospital. SBIRT is covered by Medicare when an individual shows signs of substance use disorder or dependency. SBIRT treatment involves:
        • Screening: Assessment to determine the severity of the substance use disorder and
          identify the appropriate level of treatment.
        • Brief intervention: Engagement to provide advice, increase awareness, and motivate individuals to make behavioral changes.
        • Referral to treatment: If the individual is identified as having additional treatment needs, provides them with more treatment and access to specialty care.

Inpatient care
Part A covers your care if you are hospitalized and need treatment for a substance use disorder. Cost-sharing rules for an inpatient hospital stay (see number 2) should apply.

Note: If you are receiving care at an inpatient psychiatric hospital, keep in mind that Medicare only covers a total of 190 lifetime days.

Outpatient care
Part B covers outpatient care for a substance use disorder that you receive from a clinic, hospital outpatient department, or opioid treatment program. Note that some substance use disorder treatment can also be provided using technology services, sometimes called telehealth.

Original Medicare covers mental health services, including treatment for alcoholism and substance use disorders, at 80% of the Medicare-approved amount. As long as you receive the service from a participating provider or one who takes the assignment, you will owe a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, you should contact your plan for cost and coverage information about treatment for a substance use disorder. Your plan’s deductibles and copayments/coinsurance may apply.

Read More: Does Medicare Cover Prescription Drugs That Are Prescribed for Mental Health Care?
Learn About: Does Medicare Cover Opioid Treatment Programs?
Return to: Medicare In-Depth

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