Many health insurance plans, including Medicare and those offered through the Affordable Care Act (ACA) marketplace, provide coverage for substance use disorder (drug and alcohol addiction) treatment and mental health services.
Medicare covers a range of treatments for individuals with mental health and substance abuse disorders, both on an inpatient and outpatient basis. However, it’s important to note that Medicare’s coverage for these services is not as extensive as its coverage for other medical services.
Medicare Part A covers the costs associated with inpatient substance abuse treatment, and individuals are responsible for the same co-pays as they would be for any other type of inpatient hospitalization. Conversely, Medicare Part B covers outpatient treatment services provided in settings like clinics and hospital outpatient departments.
Medicare covers a variety of items and services related to the treatment of alcoholism and substance use disorders. Some of these covered services include:
SBIRT is an early intervention approach designed to help individuals who are exhibiting risky substance use behaviors but haven’t yet reached the point of a diagnosable substance use disorder. SBIRT services are typically provided in outpatient settings, such as a primary care physician’s office or hospital outpatient department. Medicare covers these services when patients show early signs of potential drug abuse or dependency.
This public health approach to substance abuse treatment is comprised of three key components:
Medicare also covers a preventive benefit that includes screening and counseling for individuals who show signs of alcohol misuse but are not alcohol dependent and don’t necessarily exhibit signs of abuse.
Moreover, Medicare covers care in specialized psychiatric hospitals that focus solely on treating mental illness when inpatient care is necessary for active psychiatric treatment. Similar to care provided in a general hospital, Medicare covers the costs of necessary inpatient hospitalization for a duration of up to 90 days per benefit period.
The Affordable Care Act mandates that all health insurance plans cover substance use disorder and mental health treatment. This law considers substance use disorder as one of the ten essential health benefits that all health insurance providers are required to cover. Consequently, no one can be denied access to health insurance due to a pre-existing condition, such as a substance use disorder.
In addition to health insurance, there are other resources available to help individuals struggling with substance abuse. For instance, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a national helpline that provides free and confidential support, guidance on treatment options, and assistance with finding a network provider.
Furthermore, organizations like the Blue Cross Blue Shield Substance Use Resource Center and UnitedHealthcare’s Substance Use Helpline offer valuable resources and support for individuals seeking treatment and recovery services. These resources provide connections to local treatment centers, support groups, and other helpful information.
It is always recommended to verify your coverage with your health insurance provider before entering a treatment program. This step ensures that you understand the specifics of your policy, including the extent of coverage, out-of-pocket expenses, and any requirements for prior authorization.
