Alcohol abuse is often treated with rehabilitation programs, both outpatient and inpatient, in hospitals and other health care facilities. Because alcohol treatment is recognized as a medical issue, public and private insurers provide coverage for its costs. Medicare considers alcohol treatment a substance abuse or mental health issue, and will provide varying levels of coverage for inpatient alcohol treatment when certain conditions are met.
Requirements
There are several conditions that must be met before Medicare will pay for costs related to inpatient alcohol treatment. First, the hospital or health care facility must participate in Medicare. In addition, a doctor or other health care provider must attest that the treatment is medically necessary and create an alcohol treatment plan for the Medicare beneficiary. Medicare must agree that the chosen plan for alcohol treatment is proper and needed by the patient before it will pay for the treatment.
Covered Services
Medicare pays for some costs associated with inpatient alcohol treatment. Medicare Part A, which covers inpatient services, provides coverage for a semi-private room, all meals, general nursing services and other basic services and supplies. Medicare Part B, which generally covers outpatient services, pays for emergency room and inpatient doctor costs. Medicare Part C Medicare Advantage plans, also known as Medicare Advantage plans, must cover at least as much as Medicare Parts A and B for alcohol treatment, and, depending on the plan, may pay for additional services and supplies. A Medicare Advantage beneficiary receiving inpatient alcohol treatment should check with the individual plan to determine what services the plan covers.
Uncovered Services
Medicare does not pay for certain inpatient alcohol treatment costs. Neither Part A or Part B covers the cost of a private room, unless a doctor declares it medically necessary. In addition, Medicare will not cover private nursing costs, extra charges for having a television or telephone in the room or for personal care items. As noted, Medicare Part C Medicare Advantage plans pay at least as much as Parts A and B, and therefore may pay for the costs of some or all of these services or items related to Medicare alcohol treatment. Because Medicare Advantage plans are purchased through private insurers, they have different coverage provisions. A Medicare Advantage beneficiary receiving inpatient alcohol treatment should therefore consult the Medicare Advantage plan with regard to the extent of coverage. All Medicare beneficiaries receiving inpatient alcohol treatment are also responsible for paying any applicable co-payments, coinsurance and deductibles. Again, a Medicare Advantage beneficiary may not be responsible for the same amount as those using Medicare Parts A and B, and should check the policy.
