Does Medicare cover rehab?
Medicare is the federal health insurance for people 65 and older and some younger people with disabilities or certain conditions. Original Medicare (Parts A and B) and Medicare Advantage plans cover addiction treatment differently, and a program has to be enrolled with Medicare.
This is general information, not a guarantee of coverage. What your plan pays depends on your plan, your state, whether the program is in network, and whether your plan decides the care is medically necessary. Call the number on your card, then the program, before you start.
What it usually covers, by level of care
| Level of care | What to expect |
|---|---|
| Detox (medically managed withdrawal) | Part A covers inpatient hospital care, including medically managed withdrawal, when it is medically necessary. |
| Residential rehab | Part A covers inpatient care in a general or psychiatric hospital (a psychiatric hospital has a 190-day lifetime limit). Medicare doesn't list residential rehab outside a hospital as a covered service, so a stay there usually isn't covered. |
| Partial hospitalization (PHP) | Part B covers partial hospitalization at a hospital outpatient department or a community mental health center, when a doctor or other qualified mental health professional certifies you'd otherwise need inpatient care. You pay a coinsurance each day after the Part B deductible. |
| Intensive outpatient (IOP) | Since January 1, 2024, Part B has covered intensive outpatient programs at hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics and, for opioid use disorder, opioid treatment programs. A doctor must certify you need at least 9 hours of services a week. |
| Outpatient therapy and medication | Part B covers counseling and substance use treatment. After the Part B deductible you usually pay 20 percent, unless you have supplemental coverage. At an opioid treatment program enrolled in Medicare, opioid use disorder treatment has no copayment, though the Part B deductible applies. |
How to check
- If you have a Medicare Advantage plan, call that plan too: it has its own network, may need prior authorization, and may charge a copayment at an opioid treatment program.
- Ask the program whether it is enrolled in Medicare and which of its services Medicare pays for.
Call a program and ask
Call the program and ask them to verify your benefits; it's free and takes a few minutes.
- Do you accept Medicare for substance use treatment, and for which levels of care?
- Are you in network for my exact plan, and is prior authorization needed?
- What would I pay a day or a week, and when is the next opening for an assessment?
Call the program yourself: Find Care doesn't take your insurance details, collect your name or pass anything to a program for you. This is general information, not a guarantee of coverage. What your plan pays depends on your plan, your state, whether the program is in network, and whether your plan decides the care is medically necessary. Call the number on your card, then the program, before you start.
Sources to check this against: Medicare.gov: mental health and substance use disorders · Medicare.gov: intensive outpatient program services · Medicare.gov: partial hospitalization · Medicare.gov: opioid use disorder treatment services · CMS: 2024 hospital outpatient rule (the new intensive outpatient benefit). Written by Find Care as general information; not reviewed or endorsed by any of them.
Programs that list Medicare
- Texas 178
- Arizona 148
- Kentucky 139
- Tennessee 97
- Louisiana 84
- Colorado 75
- Missouri 74
- Alabama 58
- Kansas 53
- New Mexico 53
- Arkansas 51
- Oklahoma 47
- Mississippi 36
Counted by organization, only where at least 3 list it. Not every program that takes Medicare says so publicly.
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If you are in crisis, call or text 988. For help finding treatment, SAMHSA's National Helpline is 1-800-662-4357.