Alcohol misuse refers to drinking habits that are unhealthy but do not yet meet the medical requirements for alcohol dependency. Screening and counseling may help identify, manage, and treat alcohol misuse.
Medicare Part B covers an annual alcohol misuse screening. You do not need to show signs or symptoms of alcohol abuse to qualify for this screening. However, Medicare only covers counseling afterwards if your primary care provider (PCP) determines you are misusing alcohol, meaning you are:
- A woman under age 65 who has more than three drinks at a time or seven drinks per week
- A man under age 65 who has more than four drinks at a time or 14 drinks per week
- An individual age 65+ who has more than three drinks at a time or seven drinks per week
If your PCP determines that you are eligible, 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 at the time counseling is provided
- Be counseled in a primary care setting (a doctor’s office or a clinic)
- Be counseled by your PCP (a doctor or a nurse practitioner)
Be aware that Medicare will not cover alcohol misuse screenings or counseling received while in an emergency room or during an inpatient hospital stay.
If you qualify, Original Medicare covers annual alcohol misuse screenings, as well as counseling, at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover alcohol misuse screening and counseling without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
Note: Medicare also covers inpatient and outpatient treatment for alcoholism and substance use disorder. Services for the treatment of substance use disorder and dependency are not considered preventive care, meaning you may have to pay Medicare cost-sharing.