Medicare is a type of insurance that can help veterans struggling with substance abuse find treatment. Whether you are dealing with opioid use issues, alcoholism, tranquilizer abuse, or something else, Medicare can help veterans of the age of 65 start the journey to recovery. While Medicare is generally reliable as an insurance, there are different types of Medicare, eligibility requirements, and limitations.1 Understanding how Medicare works can help veterans seeking substance abuse treatment take full advantage of the program.
Table of Contents
- What is Medicare?
- Medicare Eligibility Requirements
- Can Veterans Apply for Medicare?
- Does Medicare Cover Rehab?
- Can I have Medicaid and Medicare?
What is Medicare?
Medicare is a government-funded insurance program that helps provide healthcare to individuals over the age of 65. Medicare was signed into law in 1965 by President Lyndon B. Johnson.2 Today, Medicare helps provide healthcare to millions of eligible Americans every year. Medicare consists of three parts:3
Medicare Part A: Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care.
Medicare Part B: Covers doctor office visits and services, outpatient care, medical supplies, and preventative care and services.
Medicare Part D: Covers the cost of prescription drugs, flu shots, and vaccines.
You can combine all three parts of Medicare for comprehensive coverage. Additionally, there are two types of Medicare plans:3
Original Medicare: The original Medicare program includes Medicare Part A and Medicare Part B. With Original Medicare, you pay a coinsurance fee, which is about 20% of the cost of service. You can add a prescription drug plan (Part D).
Medicare Advantage: This is a bundled “all in one” plan that includes Part A, Part B, and usually Part D. This plan also provides extra services that Original Medicare doesn’t cover.
Many substance abuse facilities accept Medicare for drug rehab treatment. People may use a variety of different insurances to cover drug rehab, including Medicare. In 2017, of the more than 13,500 substance abuse treatment facilities, over 35% (about 4,767) accepted Medicare as a form of payment.4
Medicare Eligibility Requirements
If you meet the eligibility requirements, you can enroll in and obtain Medicare. These requirements are as follows:3
- You are age 65 or older.
- You are younger than 65 but have certain disabilities.
- You have been diagnosed with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Meeting these eligibility requirements is an important first step in accessing Medicare rehab coverage for substance abuse.
Can Veterans Apply for Medicare?
If you are a veteran and meet the eligibility requirements listed above, then you may be able to enroll in Medicare. If you decide you want Medicare insurance, it’s important to enroll at the right time. If you don’t, you will incur a late-enrollment penalty.5 The enrollment period is seven months long, so there is adequate time to get in on the program. The enrollment period usually begins three months before you turn 65, includes the month of your birthday, and extends three months after your birthday has passed.5
If you’re wondering how to get started finding out more information about enrollment, or you are near your 65th birthday now, you can visit the Medicare.gov website. Use the links to find the appropriate page based on your situation. Select the one that fits you and follow the steps on the next page.
Do I Need Medicare If I Have VA Benefits?
Veterans are covered by their VA benefits, but those benefits are not the same for each recipient. Also, these benefits may not cover every aspect of addiction treatment that you need.1 While you do have a choice regarding Medicare enrollment, there is no reason not to enroll. Medicare simply adds to your VA benefits; it doesn’t take anything away from them.1 So, for example, if your VA benefits are not accepted at a certain facility or don’t cover certain rehab treatments, you can use the Medicare rehab coverage as a supplement. In some instances, Medicare may be the primary source of insurance for your rehab treatment.
The other benefit of enrolling in Medicare is that you might not always have VA coverage.1 Then, if you haven’t enrolled in Medicare, you will have to pay penalties and possibly wait a while to get into the program.1 Instead, veterans can have both insurances at once, so they will be ensured of adequate coverage.
Does Medicare Cover Rehab?
Medicare can be used to cover the cost of addiction treatment for veterans. It will allow recipients to participate in Medicare substance abuse programs. Whether you need inpatient hospital rehab or a partial hospitalization program, you can access your Medicare rehab coverage to help with the costs. Make sure to let the rehab coordinator know that you have both insurances—VA benefits and Medicare coverage. Even though the VA healthcare benefits and Medicare insurance are federally funded they are operated by different agencies.1 Both insurances can be used simultaneously for the best substance abuse coverage.1
You can check to see if a certain rehab facility is covered by Medicare by contacting the facility or checking this site. Verifying whether a facility accepts Medicare is fast and easy. You can always call the number on the back of your Medicare card too.
What Types of Services Does Medicare Cover?
Medicare covers an array of addiction rehab services for veterans. These services fall under the behavioral and mental health services for Medicare recipients. Veterans seeking assistance for substance use disorder may be able to obtain Medicare drug and alcohol rehab coverage for the following services:6
- Detox: This program may include types of medication-assisted treatment (such as methadone and buprenorphine).
- Inpatient hospital treatment: During an inpatient program, you will have continual supervision and access to treatment.
- Outpatient treatment programs: You can attend treatment programs that range in intensity and duration.
- Counseling: Speak to a licensed counselor and find help for the root cause of your addiction.
- Therapy: Individual and group therapy can be beneficial.
- Online/Telehealth: If you can’t make it to the facility, you can participate in virtual two-way communication with a provider.
Does Medicare Cover Medications?
Medication-assisted treatment (MAT) is a type of treatment program sometimes offered at addiction treatment facilities. Medicare covers MAT programs as a comprehensive benefit under Medicare Parts A, B, and C, and some falls under Part D.7
A MAT program uses medication combined with behavioral therapy to assist people with substance use disorder, especially opioid use disorder. The following drugs have been approved by the FDA for this purpose:7
- Buprenorphine, a component of Suboxone, is used to treat opioid addiction.
- Methadone, used for heroin or other opiates.
- Naltrexone, used for opioid or alcohol use disorder.
Can I have Medicaid and Medicare?
When someone has both Medicare and Medicaid, they are considered to have “dual eligibility.” 8 This means they are eligible to receive coverage from both of these government-funded institutions. It’s fairly uncommon to have both at the same time; the eligibility requirements for Medicaid and Medicare can be difficult to meet. Further, Medicaid eligibility requirements vary by state, whereas Medicare’s eligibility requirements are set by the federal government. About 20% of people receiving Medicare also receive Medicaid, which is 12.1 million people.8 These requirements are discussed further in the section below.
If you’ve already enrolled in Medicare, you should attempt to apply for Medicaid as well. Having multiple insurance policies will assist you in getting your addiction treatment costs paid for.
Medicaid vs Medicare: What’s the Difference?
Medicare and Medicaid are both federally funded programs.9 Medicaid is a joint federal and state program with funds and eligibility being distributed at the state level. Every state has its own eligibility requirements for receiving Medicaid, but it’s always based on income.9 People who are in the lower-income bracket are usually eligible. You can check with your state to find out what the income limitations are for your family size.9 Medicaid also has limits on how much resources you can have.9 However, veterans who are a little bit above the income parameters can “spend down” their income and become eligible. This process is accomplished by subtracting medical expenses from your income.9
Seeking treatment for substance use disorder promptly is critical for your well-being. Take the time today to verify your Medicare coverage with a rehab facility of your choice.
- AARP. (n.d.). I am a veteran with health care coverage from the VA system. Do I need Medicare as well?
- The Medicare Resource Center. (2021). A brief history of Medicare in America.
- Medicare.gov. (n.d.). What’s Medicare?
- U.S. Department of Health and Human Services SAMHSA. (2017). 2017 State Profile — United States and Other Jurisdictions National Survey of Substance Abuse Treatment Services.
- AARP Medicare Plans. (n.d.). When to Enroll in Medicare.
- Centers for Medicare and Medicaid Services. (n.d.). Medicare & Your Mental Health Benefits.
- Congressional Research Service. (2020). Medicare Coverage of Medication Assisted Treatment (MAT) for Opioid Addiction.
- Medicare Resources.org. (2020). Can I be enrolled in Medicare and Medicaid at the same time?
- Medicaregov. (n.d.). Medicaid.