Medicare covers alcoholism and substance abuse treatment 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
  • Prescription drugs administered during a hospital stay or injected at a doctor’s office
    • Methadone may be covered in inpatient hospital settings, but it is not covered in outpatient clinics where it is supplied orally
  • Outpatient prescription drugs covered by Part D
    • Part D plans must cover medically necessary drugs to treat substance abuse
      • Part D plans cannot cover methadone or similarly administered medications to treat substance abuse, but they can cover methadone for other conditions, such as pain.
  • Structured Assessment and Brief Intervention (SBIRT) services provided in a doctor’s office or outpatient hospital. SBIRT is covered by Medicare when individual shows signs of substance abuse or dependency. SBIRT treatment involves:
    • Screening: Assessment to determine the severity of substance use and identify the appropriate level of treatment.
    • Brief intervention: Engagement to provide advice, increase awareness, and motivate individual to make behavioral changes.
    • Referral to treatment: If individual is identified as having additional treatment needs, provides them with more treatment and access to specialty care.

Inpatient care

Part A should cover your care if you are hospitalized and need substance abuse treatment. Your plan’s cost-sharing rules for an inpatient hospital stay 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 should cover outpatient substance abuse care you receive from a clinic or hospital outpatient department.

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

Note: Medications used to treat substance abuse can be covered under Part A. They are not generally covered by Part B or Part D.