Medicare covers annual screenings and counseling to reduce alcohol misuse.

You misuse alcohol if you have drinking habits that go beyond recommended levels but you are not yet considered alcohol dependent.

Someone is considered to be misusing alcohol if they are a:

  • Woman under the age of 65 who has more than three drinks at a time or seven drinks per week
  • Man under the age of 65 who has more than four drinks at a time or 14 drinks per week
  • Person over the age of 65 who has more than three drinks at a time or seven drinks per week

Medicare will pay for annual alcohol misuse screenings for people with Medicare. You do not need to show any signs or symptoms of abuse to qualify for the preventive screening.

If the annual screening shows that you misuse alcohol, Medicare will pay for up to four, brief counseling sessions every year.  To qualify for Medicare coverage of these counseling sessions, you must:

  • Be considered mentally competent
  • Be counseled  in a primary care setting (i.e. a doctor’s office or a clinic)
  • Be counseled by a primary care provider (i.e. a doctor or a nurse practitioner)

Medicare will not cover alcohol misuse screenings or counseling you get while in an emergency room or during an inpatient hospital stay.

If you have Original Medicare, you will not have to pay a deductible or coinsurances for alcohol misuse and counseling as long as you use providers who accept assignment. If you have a Medicare Advantage Plan (private health plan), you will not have to pay a deductible, copay or coinsurances as long as you see network providers.

Medicare also covers inpatient and outpatient treatment for alcoholism and other substance abuse. Services for the treatment of alcohol dependency and abuse are not considered preventive care and therefore you may have to pay a coinsurance or deductible.