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Do Medicare and Medicaid Cover Addiction Treatment?

Addiction is a chronic and progressive disease that must be treated by a professional rehab program. Due to the intricacies of treating substance use disorders, the cost of treatment can become extremely high. Unfortunately, this causes a large number of people to avoid attending treatment altogether. 

Thankfully, most addiction treatment centers accept insurance, cutting some of the out-of-pocket costs that individuals are responsible for. Some of the most common insurances in America are known as Medicare and Medicaid. According to the Centers for Medicaid and Medicare Services, “Medicare and Medicaid cover nearly 1 out of every 3 Americans—that’s well over 100 million people.”[1]

With that being said, people who have Medicaid and Medicare often worry about what their policy covers. Many individuals believe that these insurances will not cover addiction treatment, however, this is farthest from the truth. Many drug and alcohol rehab programs accept these insurances. 

What is Medicaid?

Medicaid is an insurance-assistance program for low-income individuals. Despite having federal guidelines, this insurance is run by state and local governments. This means that people can check with their local governments to see if they qualify for Medicaid. 

This insurance program offers coverage to over 72.5 million Americans, including children, parents, pregnant women, seniors, and people with disabilities.[2] To receive this type of insurance, people must be suffering from a low-income situation, require health care assistance, and be current residents of the state they are living in. Other people who qualify for this type of insurance include pregnant women, children, and individuals receiving Supplemental Security Income (SSI). 

What is Medicare?

Medicare is a form of insurance that is provided to disabled individuals or adults over the age of 65. This insurance is available across the United States because it is a federal program. 

According to Medicare, this insurance is available to the following people:[3]

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Do Medicaid and Medicare Cover Addiction Treatment?

While many people worry that programs like Medicaid and Medicare will not cover services such as addiction treatment, these programs are required to cover substance abuse rehab. Two different health care reform laws known as the Affordable Care Act (ACA) and (Mental Health Parity and Addiction Equity Act) MHPAEA have made this possible. 

The Affordable Care Act, also known as Obamacare, was passed in 2010. This law was created to ensure that everyone could access affordable health care while guaranteeing more choices to individuals from low-income families. Additionally, this act highlights the necessity of addiction treatment by including it as an essential aspect of healthcare benefits

The Mental Health Parity and Addiction Equity Act (MHPAEA) is described as a law that stops insurance from limiting their client’s access to mental health and addiction treatment services. In other words, this act helps people receive the addiction care they need without insurance forcing them to pay for rehab out-of-pocket.

So, yes, Medicare and Medicaid both cover addiction treatment programs. However, certain rehab programs may not accept these insurances because they are out-of-network. Because of this, individuals need to know how to research which facilities accept their insurance.

Finding an Addiction Treatment Center That Accepts Medicaid and Medicare

Finding an addiction treatment center that accepts Medicaid and Medicare can be difficult. There are unlimited options in the United States when it comes to addiction treatment, however, not every facility will accept this type of insurance. This is where the person seeking help must do a little research to determine which programs will accept their insurance.

First, individuals seeking addiction treatment that accepts Medicaid or Medicare should reach out to their insurance provider. Every insurance company will provide its client with a list of facilities and doctors depending on the type of specialty. So, to find local rehab programs an individual must contact their insurance to receive a list of accepting facilities. 

If someone is interested in specific programs that might be far from home or out-of-state, they should consider contacting the program directly. When an individual speaks with an addiction treatment facility, they can ask what types of insurance they accept. This is the best way to determine whether the program someone is interested in accepts Medicaid or Medicare. 

Another way to find out what programs accept Medicaid and Medicare are by working with a team of addiction professionals like Mandala Healing Center. Not only will they help a person find a treatment center that accepts their insurance, but they can also ensure that the rehab specializes in their unique needs.

Get Connected With a Top-Rated Addiction Rehab That Accepts Your Insurance

If you or a loved one requires addiction treatment but are unsure of which programs accept your insurance, contact Mandala Healing Center today. We can help you find a treatment program that takes your insurance, specializes in the services you need, and is the overall best fit for you. 

References:

  1. https://www.cms.gov/Outreach-and-Education/Look-Up-Topics/50th-Anniversary/Long-Form-Drop-In-Article.pdf
  2. https://www.medicaid.gov/medicaid/index.html
  3. https://www.benefits.gov/benefit/1625