Medicare helps pay for a variety of mental health services, but will it cover treatment for substance abuse?
The rate of substance abuse has increased in adults 65 and older since the beginning of the pandemic. Opioid-related deaths increased in this age group by 53% from the previous year, and alcohol-related deaths rose by 18%.
If you or someone you love is struggling with substance addiction or mental health issues, it’s important that you know that Medicare covers some screenings, services, and programs for such disorders.
Medicare coverage of mental health and substance use disorders
For the most part, Medicare Part B (medical insurance) covers services that treat mental health and substance use disorders. However, Medicare Part A covers mental health care services you receive when admitted as a hospital patient.
It’s important to note that even though Medicare covers some substance abuse counseling and mental health services, it’s imperative that you understand your out-of-pocket costs before receiving services.
Here’s what you need to know about Medicare coverage for alcohol, tobacco, and opioid use disorders. Additionally, we will discuss Medicare coverage of depression screenings – and inpatient, outpatient, and telehealth services for mental health disorders.
Medicare Part B covers a yearly alcohol misuse screening for adults who don’t meet the medical criteria for alcohol dependency.
Following this screening, if your primary care doctor determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions yearly, which must occur in a doctor’s office or primary care setting. To qualify for the counseling sessions, you must be competent and alert.
Your healthcare provider may recommend you get additional services for alcohol misuse. However, you must understand your out-of-pocket costs for such treatment, as you may have to pay for some or all of those expenses.
Related reading: How Much Alcohol Can You Drink As Part of a Healthy Diet?
Medicare Part B covers up to eight smoking and tobacco-use cessation sessions in a 12-month period. However, the healthcare provider must accept the Medicare assignment for it to be covered.
Even though Medicare Part B covers the counseling sessions, there may be some out-of-pocket costs. The amount depends on how much your doctor charges and the type of facility where you receive your counseling – among other factors.
Related reading: 9 Tips to Quit Smoking (And How Medicare Can Help)
Opioid use disorder treatment services typically include individual and group therapy, drug testing, and education.
Medicare Part B covers opioid use disorder treatment services as long as the provider is enrolled in Medicare and meets other requirements. However, you may have to pay the Part B deductible for supplies and medications you get during treatment.
Medicare Advantage plans must also cover opioid treatment program services.
Related reading: How to Find Help for Opioid Dependence at Any Age
Depression, anxiety, and other mental health disorders
Medicare’s coverage for mental health disorders depends on whether the treatment is outpatient, inpatient, or telehealth.
Medicare Part B pays for one depression screening per year if it occurs at a primary care clinic that can provide follow-up treatment and referrals.
Medicare Part B also covers individual and group therapy, certain types of family counseling, testing and evaluations, medication management, some prescription drugs, and a yearly mental health wellness visit.
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for your treatment. If you receive services in a hospital outpatient clinic, you may have to pay additional copayment or coinsurance.
Medicare Part A (hospital insurance) covers mental health services when admitted as a hospital patient in either a general or psychiatric hospital. However, Medicare Part B covers the services you get from a healthcare provider while in the hospital.
It’s also worth noting that Medicare Part A pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.
Here’s how an inpatient stay works with Original Medicare (Parts A & B).
For each benefit period, you pay a $1,600 deductible. For days 1 through 60, you pay nothing. For days 61 through 90, you pay a $400 copayment per day. For days 91 and beyond, you pay an $800 copayment per each lifetime reserve day. (You have 60 reserve days over your lifetime.) After your lifetime reserve days are used, you must pay for all the costs.
Additionally, you must pay 20% of the Medicare-approved amount for mental health services you get from healthcare providers while you’re a hospital inpatient.
Telehealth includes certain services from your healthcare provider using audio and video communications technology.
Medicare Part B covers specific telehealth services. However, it’s worth noting that you’ll pay the same amount for many telehealth services if you get them in person.
Medicare Advantage Plans and providers in certain Medicare Accountable Care Organizations (ACOs) may offer more telehealth benefits than Original Medicare.
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for telehealth services.
Key takeaways about Medicare’s coverage of substance abuse treatment and mental health issues
It’s imperative that you understand your out-of-pocket costs before receiving treatment. The amount you owe depends on a lot of factors, including the following:
- If you have an additional form of insurance
- How much your doctor charges
- If the doctor accepts Medicare assignments
- The type of facility where you receive your treatment, test, item, or service
- The type of provider giving the service
In general, though, Medicare covers 80% of the approved amount (meaning the amount the Centers for Medicare & Medicaid Services has negotiated for the service in question). This leaves you paying the remaining 20% as coinsurance.
Remember that Medicare Advantage plans cover everything Original Medicare does – and then some. Nearly 99% of MA plans offer additional benefits, and out-of-pocket costs for services may be cheaper than your coinsurance as well.
Or, you can look at Medigap plans. They don’t offer any additional benefits, but they will cover some – or even all – of your out-of-pocket cost for services covered by Medicare.
Comparing Medicare plan options is easy with our Find a Plan tool. Just enter your zip code to start reviewing benefits and costs of Medicare plans in your area.