Who this page is for
Medicare is federal health insurance, mainly for people 65 and older and some younger people with disabilities. If your parent or spouse has Medicare and is drinking or using, this page explains what Medicare.gov says it covers for mental health and substance use disorders.
Some programs don’t accept Medicare at all. Knowing which part of Medicare pays for which kind of care helps you ask better questions when you call.
If your loved one has a Medicare Advantage Plan, the plan must cover the services Original Medicare covers, but its network, approvals and costs can differ. Call the plan before choosing a program.
What each part of Medicare covers
| What Medicare.gov says it covers | What it means for rehab | |
|---|---|---|
| Part A (Hospital Insurance) | Services you get when you are admitted to a general or psychiatric hospital as an inpatient | Inpatient hospital care, which may include medically needed detox in a hospital |
| Part B (Medical Insurance) | Outpatient services, including those you might get as part of substance use disorder treatment, plus doctor services while you are in the hospital | Counseling, therapy and doctor visits for a substance use disorder |
| Part B: intensive outpatient | Services at a hospital, community mental health center, Federally Qualified Health Center, Rural Health Clinic or Opioid Treatment Program | IOP care for people who need at least 9 hours of services a week |
| Part B: partial hospitalization | Services through a hospital outpatient department or community mental health center, if you meet certain requirements | PHP care for people who need at least 20 hours of services a week |
| Part D (drug coverage) | Many outpatient prescription drugs | Some medications used in treatment, depending on the plan’s drug list |
Other Medicare services that help
- Opioid use disorder treatment. Medicare.gov lists counseling, therapy, assessments and more to help people recover from opioid use disorder. Read about medication-assisted treatment in Jacksonville.
- Alcohol misuse screenings. Medicare covers screenings to identify unhealthy drinking and counseling needs. This can be a gentle first step with a primary care doctor.
- Behavioral health integration. Part B covers services to help manage care for a behavioral health condition.
Medicare.gov also notes that if someone is eligible for both Medicare and Medicaid, they may have even more coverage. If that may be your loved one, see our Florida Medicaid page.
Medicare.gov’s coverage page does not list residential rehab as its own benefit. If a program calls itself residential, ask exactly which services Medicare will pay for there before admission.
How to check Medicare coverage for a program
Confirm the program accepts Medicare
Not every treatment center does. Ask the admissions team directly.
Ask how the care is billed
Ask whether the care is billed as inpatient hospital, partial hospitalization, intensive outpatient or outpatient services.
Ask about your share
Ask what the deductible, coinsurance or copay will be for your loved one, and get it in writing.
Parity rules and Medicare
Be aware that the federal parity law (MHPAEA) does not apply to Medicare plans, according to the U.S. Department of Labor. Medicare sets its own rules for mental health and substance use care. That is another reason to call and ask instead of assuming.
For our full guide to checking any plan, see does insurance cover rehab. For questions to ask the center, use our verification questions.
Medicare and rehab: common questions
Does Medicare cover detox?
Medicare Part A covers inpatient care when someone is admitted to a general or psychiatric hospital. Whether a specific detox program is covered depends on how it is set up and billed, so ask the program and Medicare before admission. See our detox guide.
Does Medicare cover outpatient addiction treatment?
Yes, Medicare.gov says Part B covers outpatient services, including services you might get as part of substance use disorder treatment, as well as intensive outpatient and partial hospitalization services when requirements are met.
Does Medicare cover methadone or buprenorphine?
Medicare.gov lists treatment for opioid use disorder among covered services, including through Opioid Treatment Programs. Talk with the doctor and the plan about which medications and settings are covered.
Where can I get help comparing Medicare options?
Start at Medicare.gov’s mental health and substance use page. You can also call the member number on a Medicare Advantage or Part D card.
What if my parent won’t accept help?
That is common, and it isn’t the end of the story. Our help for families section has ideas for starting the talk. In an emergency, call 911. For a crisis, call or text 988.