Will Medicaid & Medicare Pay for Rehab? - Solutions Recovery

Will Medicaid & Medicare Pay for Rehab?

Many detox facilities across the country, including those in Nevada, accept Medicaid and Medicare. Given the prevalence of substance use disorders in the U.S., the Center for Medicaid Services (CMS) has made an effort to include substance abuse treatment in their plans; however, coverage can vary by state..5

Federal law requires that certain substance abuse services be covered. However, it is up to the state to determine which optional services are included under Medicaid. Some benefits commonly included under Medicaid include:6 (page 7, 8, 9)

  • Diagnostic services.
  • Rehabilitation services (e.g., medication-assisted treatment, detox, inpatient treatment, crisis intervention, counseling, peer support services).
  • Case management services.
  • Home and community-based services.

Medicare also offers substance abuse treatment coverage if the services are considered necessary and reasonable. Such services may include:7(pages 1-3)

  • Inpatient/residential treatment.
  • Outpatient treatment including individual and group therapy.
  • Partial hospitalization programs (PHPs).
  • Family counseling.
  • Medication
  • Diagnostic services.
  • Patient training and education.

What are Medicaid & Medicare?

Medicaid and Medicare are federally funded insurance programs. When you hear the word Medicaid, you may also have heard of CHIP. CHIP stands for Children’s Health Insurance Program, a component of Medicaid that addresses the insurance needs of minors.

Medicaid and Medicare are available in all 50 states plus the District of Columbia. As of November 2020, almost 80 million people in the United States were enrolled in Medicaid and CHIP programs.1 The number of Medicare enrollees is slightly lower than that of Medicaid and CHIP, with approximately 63 million Americans enrolled in a Medicare plan in 2020.2

How Do I Check My Medicaid/Medicare Coverage?

Whether you have Medicare or Medicaid, it is important to understand the benefits and coverage for substance abuse treatment. You can call the number on the back of your insurance card to verify your benefits.

If you’re trying to find rehab centers who accept Medicaid or Medicare,

The Substance Abuse and Mental Health Services Administration (SAMHSA)—a component of the US Department of Health and Human Services—offers information and support regarding mental health and substance abuse services across the United States.

You can utilize the SAMHSA directory or go to www.samhsa.gov to search for private and public substance abuse treatment facilities in Nevada and across the entire country. Many private treatment centers accept Medicaid and Medicare. Some facilities display which insurance carriers they accept on their website; others may require you to call them to verify coverage. You can also call the number on the back of your insurance card to see which treatment centers near you accept Medicaid and Medicare.

Using Medicaid & Medicare in Nevada

Medicaid and Medicare are similar in that they are both funded by the United States government. However, they differ in the populations they serve, eligibility criteria, cost, and coverage. Let’s take a deeper look into the 2 programs.

Medicare is specific to individuals 65 and older. Medicare is funded by participants paying into the program throughout their lives. It also covers younger people with certain disabilities as well as dialysis patients.3 Unlike Medicaid, Medicare recipients can expect to pay for certain things such as deductibles and monthly premiums. Also, unlike Medicaid, Medicare coverage is consistent across the country, with little to no variation between the states.

Medicaid is considered an assistance program and provides services for low-income individuals regardless of age.3 While the program follows federal guidelines, each state has the power to determine eligibility criteria and other parameters. Medicaid generally requires no out-of-pocket costs for medical services received.3 You may be able to verify your eligibility for Medicaid online through your state’s Medicaid page.

In Nevada, you may be eligible for Medicaid if you:

  • Live in the state of Nevada.
  • Are a resident of the United States, legal alien, or permanent resident.
  • Are considered low income or very low income.
  • Are blind.
  • Are pregnant.
  • Are responsible for a child under 18 years of age.
  • Have a disability or have a family member with a disability.
  • Are 65 years of age or older.

Using Dual Enrollment for Rehab

Dual enrollment refers to people who qualify for both Medicare and Medicaid services. For example, if you are 65 or older, under 65 with disabilities, or, have a qualified diagnosis, you may be eligible for Medicare; if you are also eligible for Medicaid in your state, you may qualify for enrollment in both programs. It is true that Medicare and Medicaid cover many of the same services. If you are eligible for both programs, Medicare will pay for the services covered by both programs and your Medicaid may be able to cover costs associated with Medicare, such as deductibles, copayments, and coinsurance.4(background discussion and 3rd paragraph under dual-eligibility beneficiaries)

How Does The Affordable Care Act Help Me Go to Rehab?

Historically, substance abuse treatment coverage was not commonly included in many insurance plans. Many Americans were unable to obtain the treatment they needed. With the emergence of the opioid crisis, the government realized that greater access to substance abuse treatment was necessary. The Affordable Care Act (ACA) was developed in response. Passed in March 2010, the ACA greatly expanded substance abuse and mental health treatment coverage. It provides more access to substance abuse treatment and mandates that substance abuse treatment coverage is available when needed, in the same way that surgical and other medical procedures are available as needed.8

The ACA also expanded Medicaid coverage to individuals who were previously ineligible. Approximately 1.6 million Americans with a diagnosable substance use disorder have received Medicaid coverage through the Medicaid expansion as a result of the ACA.8 The primary impact of the ACA is on Medicaid; little research is available on changes it has made to Medicare coverage.

What Rehab Options are There for People Without Medicaid or Medicare?

American Addiction Centers (AAC) is a leading provider of detox and rehab in Nevada and across the United States. If you are considering seeking treatment for drugs or alcohol, AAC is available to help answer any questions you may have about treatment. We can also verify insurance coverage at our treatment locations and give you a full understanding of your options.

Recovery is possible, and help is available. Addiction doesn’t wait; neither should you. Start your recovery journey with a simple phone call today.

You are not in this alone

Our Admissions Navigators are here to help you take back control of your life.