What’s The Difference Between Medicare And Medicaid Drug Rehabilitation?

The terms Medicare and Medicaid are often thrown together when it comes to affordable insurance. Seeking addiction treatment can seem hopeless, especially if you fear the ability to pay for it. 

The Affordable Care Act of 2010 expanded coverage and benefits to tackle an extended range of conditions and insurance laws. Luckily, some rehabs take Medicaid and Medicare for the elderly and those with low income.

Medicare and Medicaid are federal and state programs designed to fill in the cracks of healthcare funding. Medicare provides coverage for anyone 65 years old or older. Medicaid covers individuals under the age of 65, with a disability, or children. Medicare and Medicaid coverage is only applicable to rehabilitation programs that accept them.

The perspective on addiction has shifted over the past couple of years. Addiction is a chronic but treatable disease, like diabetes. Addiction can be classified as the inability to control cravings for a substance or behavior. Addiction is also recognized as a family disease, impacting development and interpersonal relationships.

Many individuals who misuse substances are struggling with unhealthy coping mechanisms. The link between mental illness and substance use has influenced negative trends across the globe. The stigma of addiction plays a large factor in whether a person enters treatment or not. 

What Is Medicare Drug Rehabilitation?

Medicare drug rehabilitation is an insurance program that helps individuals pay for mental health and/or substance use disorder treatment. It does not cover all types of benefits offered by private plans, but it does provide additional coverage for services such as dental care and eyeglasses. 

Medicare may also help individuals with a mental illness or a substance use disorder who have no other form of insurance to pay for their recovery needs. The rules about what type of service will be covered will depend on the individual’s situation and diagnosis; whether or not they are in conventional rehabilitation or dual diagnosis treatment facilities.

If you are struggling with a substance use disorder, you may qualify for Medicare benefits. There are more than 58.5 million beneficiaries enrolled in Medicare. Medicare covers mental health services. For Medicare to kick in, your provider must accept it. It should be noted that Medicare does not cover 100% of the costs. 

How Does Medicare Rehabilitation Handle Coverage?

Medicare can be broken down into 4 parts (A, B, C, D). If medically necessary, Medicare Part A will cover inpatient treatment. Medicare B will cover outpatient treatment. Medicare Part C is specified for private companies, providing additional coverages. Medicare Part D will cover the medication required to treat a substance use disorder.

You could be responsible for the cost of services recommended by your physician that are impactful on your treatment. A patient can expect to pay a reduced deductible. 

Medicare will cover the following:

Part B of Medicare will recognize these providers:

Additionally, Part B will cover:

If you have a co-occurring disorder, Medicare could be a viable option for you. A co-occurring disorder requires proper treatment to manage the mental health and substance use disorder.  Dual diagnosis treatment has reported positive outcomes for patients who receive quality care that address their specific needs.

Who Qualifies For Medicare?

Individuals who are the age of 65 and over will qualify for Medicare drug rehabilitation, if the provider accepts. Individuals under the age of 65 with specific disabilities or illnesses may qualify. You may be subject to copays and deductibles. 

The provider you have chosen for treatment must set up the plan of care. This is a common misconception about Medicare. It only pays the bills, it is up to the provider and patient to set up a treatment plan.

What Are The Origins Of Medicaid And Medicare Rehabilitation?

Medicaid and Medicare were first signed into law in 1965, under Title XIX of the Social Security Act. Every state has a Medicaid program to aid individuals with low income or disabilities. Through the federal government guidelines, each state determines the eligibility parameters. 

In 1997, The Children’s Health Insurance Program was signed into law. The CHIP 1997 was implemented to cover children with parents with too high income for Medicaid. All states have expanded coverage through CHIP programs.

With this program, you can receive your treatment and get paid back by Medicare. The most beneficial part about drug rehab centers is that they not only offer treatment services but give other forms of help such as counseling to aid you in fighting your addiction. 

Drug rehab centers will provide an individualized plan for each patient coming through its doors. They review a person’s mental and physical issues, see what the problem is and come up with a way to treat it. 

Once complete, they put together a specific care plan that may include attending meetings or going out into the community to talk about their experiences with others who have been in similar situations. Since every person’s circumstances are different, there isn’t one fixed price for all outpatient drug treatment.

How Is Medicaid Different From Medicare?

To differ from Medicare, Medicaid provides coverage to low-income adults, children, and individuals with disabilities. As of March 2021, there are 74 million Americans enrolled in Medicaid. Medicaid is federally and state-funded, with varying guidelines by each state. Medicaid provides a tremendous amount of coverage for mental health services. 

Medicaid can supplement your private insurance. It’s encouraged for other payment sources to cover costs before Medicaid is introduced. Reach out to the treatment facility you’ve chosen to determine what payment methods they accept. Medicaid isn’t always available to everyone who needs it though. Low-income families and individuals without dependent children aren’t typically eligible.

 Medicaid Drug Rehabilitation

Medicaid drug rehab eligibility is determined by income level:

Additionally, people who are 138% above the federal poverty line may qualify for Medicaid. In 2018, Medicaid was the source of payment for 42.3% of US births. State-funded detox and rehab programs are an alternative option for those seeking affordable addiction treatment. There are state-funded residential and outpatient treatments.

Does Medicaid Cover Drug Rehab?

The length of Medicaid coverage depends on the individual case as there is no predetermined length of time for applied coverage. The recommended length of addiction treatment is at least 90 days. 

Each state will deliver its own sets of guidelines for Medicaid coverage. Under ACA 2010, insurance companies must provide a full scope of treatment services, including residential treatment for substance use. All states will have some form of mental health services through Medicaid.

Medication-assisted treatment is a vital resource towards addiction recovery. Medications such as Methadone, Buprenorphine, and Naltrexone are used to treat patients with withdrawal symptoms. Detox lays the foundation for addiction recovery, as the body requires an absence of substances to fully receive treatment.

How Do I Know If I Qualify For Medicare And Medicaid?

Dual Eligible Beneficiaries are considered individuals who qualify for both Medicaid and Medicare. By enacting Medicare Parts A, Parts B, or both, you may be eligible for full Medicaid coverage or assistance with Medicare premiums. 

Cost-sharing programs are carried through Medicare Savings Programs:

How Has The Affordable Care Act Affected Treatment?

The Affordable Care Act is also known as Obamacare. It was passed to bring about changes with regards to Americans’ healthcare, including mental health treatment. The ACA mandates that many insurance policies cover the costs of mental health treatment just as they would a physical ailment.

Treatment can include residential rehabilitation, which is why it’s important for anyone with a substance abuse problem to have an individualized treatment plan. This ensures that you get the kind of care that will help you reach your recovery goals. 

Residential rehab is ideal for those who are suffering from severe addictions and need extensive medical attention but may not be covered by their current insurance plan. If you do have a substance use disorder and worry about affording treatment, here are options that might help.

The Affordable Care Act has helped many Americans receive health care coverage. But if you have a substance use disorder, it may not include drug rehab in its list of essential benefits needed to help you get healthy again. 

In some cases, the only way to pay for treatment is through a private policy that can cost thousands of dollars per month. If this is your situation, see if you’re eligible for a federal subsidy that could help cover drug rehab expenses. You can check out state-specific resources on how Medicaid might be able to assist with these costs as well.

Discover Recovery Through Sana Lake BWC

Recovery is a lifelong journey that requires a commitment and a healthy support system. With advancements in medication and therapies, addiction recovery can be readily accessible. Sana Lake works with your needs to ensure a steady recovery. If you or a loved one are struggling with addiction, please reach out to one of our facilities.

References:

https://www.medicaid.gov/about-us/program-history/index.html

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProgramBasics.pdf

https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures