Medicare Insurance

Medicare Insurance

Medicare is a federal and state-funded program that assists with healthcare costs for those 65 years and older or those with disability status determined by the Social Security Administration. Medicare provides free health insurance to over 59 million individuals. As a government insurance program, Medicare may pay for rehab services including substance use treatment, medication-assisted treatment, inpatient rehab, outpatient rehab, and aftercare services. If you are struggling with addiction and worried about how to pay for rehab, learn more about Medicare and coverage for Innovative Health’s treatment programs. 

Does Medicare Cover Rehab?

Yes, rehab is typically covered by Medicare Part A for inpatient services. Medicare regulations are based on individual state guidelines, so individual plans and benefits will vary by state. Federal guidelines require Medicare to cover mental health services and substance use treatment. The passing of the Affordable Care Act (ACA) has allowed states to expand coverage and access for individuals on the plan. All Medicare insurance plans must include at least some coverage for behavioral health such as residential treatment, counseling, mental health inpatient services, and outpatient treatment for substance use disorders. 

Addiction treatment services include inpatient and outpatient rehab, partial hospitalization (PHP), detoxification, individual and group therapy services, and continuing care. Depending on your state’s Medicare coverage, alcohol and drug rehab may be covered partially or fully. Your treatment coverage could be from 28 to 45 days. Specific coverage for treatment and services is based on your plan’s benefits and treatment services received. You can check your eligibility and enrollment online or call Medicare directly to speak with a representative. 

How much of rehab is covered by Medicare? 

When you are looking for treatment, the biggest question is usually how much is the out-of-pocket expenses for rehab? Your coverage is largely dependent on your Medicare insurance plan and the level of care you require. The Affordable Care Act made coverage for essential health services, including substance abuse treatment and mental health services, more accessible. 

Innovative Health is a rehab center that offers intensive outpatient rehab for substance use disorders. We treat alcohol and drug addiction and other mental health disorders. We are a leader in comprehensive alcohol and substance use treatment with evidence-based individualized treatment in New York state. At Innovative Health, you have several options for treatment, including telehealth services. We offer medication-assisted treatment, behavioral and mental counseling, and evaluations. 

If you have not met your plan’s deductible, you may be required to pay more out of pocket. Your out-of-pocket maximum is the most you will have to pay for covered services per year. If you are concerned that your insurance will not pay for rehab services or cover the entire cost of substance abuse treatment, payment options are available. Health insurance coverage is processed with your insurance provider. Once your claim is processed, your remaining balance will be available, and we have payment plans available to take the financial burden out of rehab. At Innovative Health, we believe everyone deserves access to addiction treatment.

Medicare  Rehab Coverage for Medication-Assisted Treatment

Medication-Assisted Treatment, or MAT, is the use of medications in combination with detox and addiction therapy to treat substance use disorders. MAT is an effective treatment that helps with withdrawal symptoms from certain substances. Medication-assisted treatment is primarily used to treat addiction to opioids and prevent an opioid overdose. 

In 2020, federal guidelines required states to increase access to medication-assisted treatment. For opioid use disorder, we provide monthly injections of Suboxone, Buprenorphine, or Sublocade. To treat alcohol use disorder, Naltrexone or Vivitrol monthly injections are available. These medications are typically covered by Medicare. 

If you require MAT, it is typically an ongoing, long-term treatment plan. Generally, MAT also requires mental and behavioral health services. You may be wondering if your insurance policy covers MAT treatment and additional treatment. Insurance for MAT works the same as coverage for any other treatment services. When you are referred for MAT treatment, your coverage will be verified. Your insurance company will be able to confirm your plan’s coverage. Health insurance that covers substance abuse typically pays for any MAT services that are considered medically necessary. 

Does Innovative Health Accept Medicare?

Insurance networks will partner with certain facilities to provide treatment services. These are known as in-network providers. Innovative Health is not in-network with Medicare insurance. Out-of-network means that your insurance plan may pay a lower percentage for your treatment. 

Innovative Health does, however, accept Medicaid. Innovative Health does work with all insurance plans, and even if you are out-of-network we will provide you treatment and care. You can find out more about your specific coverage by reviewing your benefits.

How to Verify Your Medicare Coverage

If you need a rehab center for substance use disorder treatment, Innovative Health is here to help you understand your options. You can verify your insurance through Medicare’s member services and by reviewing your benefits online or calling your provider. Innovative Health can assist you with verifying your coverage. Give us a call at 914-683-8050 for assistance with your Medicare insurance plan.