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Medicare Advantage, Alcoholism, And Substance Abuse Treatment: What You Should Know

By Zawn Villines
The law requires Medicare to cover substance abuse treatment when "reasonable and necessary." Medicare Advantage may offer additional coverage.


Addiction is a serious medical condition, not a moral or personal failing. Yet many people are too ashamed to seek treatment, or worry that they cannot afford it. The law requires Medicare plans to cover addiction treatment that is "reasonable and necessary." For some seniors, Medicare Advantage plans may offer additional coverage for drug addiction.

Will Medicare Advantage Cover Addiction Treatment?

Medicare Advantage plans have to cover the same addiction treatment as Medicare. Many Medicare Advantage plans are health maintenance organizations (HMO), which require you to seek care from an in-network provider. This may limit the care providers from whom you can get outpatient services like therapy or inpatient services like addiction rehab. You may have to get a diagnosis from a primary care provider or get a referral to treatment.

Some examples of the types of services Medicare Advantage plans may cover include:

  • hospitalization following a drug or alcohol overdose
  • inpatient rehab
  • outpatient rehab
  • therapy
  • psychiatric care, such as a consultation with a psychiatrist or a prescription for anti-addiction or withdrawal medication

Medicare Advantage plans also include special needs plans (SNP). SNPs cater to people with similar or related conditions. Some SNPs support people with chronic mental health issues, such as substance abuse. These plans may offer additional cost savings, as well as access to a wider network of addiction experts.

Other Benefits for Addiction Treatment

Many Medicare Advantage plans offer supplemental benefits you can't get with traditional Medicare. The specific supplemental benefits you can get depend on your plan. You may have to meet certain eligibility criteria, such as getting a referral from a doctor. Some supplemental benefits that may offer additional support to people living with addiction include:

  • complementary and holistic care, such as acupuncture and chiropractic care
  • nutrition and wellness consultations
  • in-home care
  • home meal delivery
  • telehealth services
  • transportation to and from medical care

Choosing a Medicare Advantage Plan

If you have an addiction, it's important to choose a Medicare Advantage plan that offers quality mental health coverage, as well as affordable coverage for the physical health issues that often co-occur with addiction. Some plan features to focus on include:

  • the plan's deductible
  • which addiction services the plan covers
  • whether your current care providers accept the plan
  • copays for mental health services
  • out-of-pocket maximums
  • coverage for supplemental benefits you use or might use
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