Whenever someone is struggling with an addiction and ready for help, the cost of the necessary treatment is a significant factor. In recent years this has become easier under the Obamacare legislation, because treatment of mental health and substance abuse disorders is now considered the same as any other medical treatment.

This kind of parity has been welcome news to both patients and providers alike.

As people get closer to their 65th birthday, they often wonder whether they will still have access to good care on Medicare. Let’s review how Medicare’s benefits for substance abuse work.

Substance Abuse Care under Medicare

Original Medicare is a form of national healthcare for people who are age 65 and over and also for people under 65 who have certain health conditions or are on Social Security disability.

Benefits are provided by the federal government and those benefits fall under two parts.

Part A is inpatient hospital coverage. It also covers blood transfusions, skilled nursing center care and hospice. When someone is hospitalized in an inpatient facility for mental healthcare or substance abuse treatment, Medicare Part A provides for up to 190 days of care in that person’s lifetime. The Medicare beneficiary will pay a Part A deductible, and then Part A covers the rest.

Occasionally people need more than this limit. If that is the case, then Medicare might provide some additional coverage for services provided in a standard hospital.

Part B is your outpatient care. It will provide for doctor’s visits and counseling, treatment in outpatient clinics, and screening for addiction. Most outpatient care that you receive for drug or alcohol abuse will be covered under Medicare Part B. Under Part B, you will pay a small deductible and then your coverage will pay for 80% of the cost of your services.

To enroll in Medicare Parts A and B, you’ll simply complete an application down at your local Social Security office or online at their website.

Prescription Coverage under Medicare

For over 40 years, there was no outpatient drug coverage under Medicare. Beneficiaries paid entirely out of pocket for their retail prescription drugs. Medicare Part D was created to help you pay for your medications. Today, however, we have Medicare Part D, which was signed into law with the Medicare Modernization Act. Part D is voluntary, but if you don’t have other coverage for medications, such as veteran’s benefits, it’s important to enroll. 

Part D drug plans are offered by private insurance companies. These plans can help to pay for prescriptions that will treat alcohol and drug addictions. Though every company has its own formulary of medications, all drug plans must include antidepressants, anticonvulsants and antipsychotic medications. You should review a plan’s drug formulary to make sure it covers your necessary medications before you enroll in it, because you can only be enrolled in one Part D drug plan at a time.

Optional Plans to Cover the Gaps

Like all other health insurance, Medicare does not pay for 100% of the cost of your care. You are responsible for deductibles, copayment and coinsurance under each part of Medicare. For example, as we mentioned above, Part B covers 80% of your outpatient medical costs, but you must pay your own deductible and the other 20%.

To cover the gaps, many people enroll in additional coverage such as Medigap plans or Medicare Advantage plans. Medigap plans are offered by private insurance companies, and the plans are standardized by the federal government. There are ten plans to choose from. One plan that is very popular in recent years is Plan G. Medigap Plan G pays for all of the gaps in your Medicare Part A and B services except for your Part B deductible. Because the plan is so comprehensive, your costs will be very predictable on the back end of your policy.

In the late 1990’s, Medicare rolled out another option called Part C or Medicare Advantage plans. This is a form of private insurance that pays instead of Medicare for your Part A and B services. You use the plan’s network or doctors and hospitals, and you pay copays for your services as you go along.

Review the plan options in your area with a reputable Medicare insurance broker to see which type of coverage will best meet your needs.

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Danielle Kunkle is a founding partner and senior executive at Boomer Benefits, a national agency specializing in Medicare-related insurance products since 2005. Serving thousands of Medigap policyholders in 47 states, her team teaches baby boomers how to navigate Medicare. She is a nationally-recognized expert in the Medicare-sector of the health insurance industry and a member of the Forbes Finance Council.

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