Does Medicare Cover Outpatient Rehab?

Currently, upwards of 60 million people are enrolled in a Medicare plan in the United States. Since it benefits many people, you might be curious to know if Medicare covers outpatient rehab for addiction. Insurance and payment options are huge topics to think about when considering rehab treatment. With rising healthcare costs, having some coverage makes paying for rehab much more manageable. Fortunately, if your doctor or mental health professional recommends outpatient rehabilitation services, help may be available through Medicare. Continue reading to get an overview of how Medicare covers outpatient rehabilitation services so you can make informed decisions about your healthcare needs.

What is included in outpatient rehab costs?

Before we go into details about Medicare and what it covers, it’s best to understand what costs someone can expect to accrue when attending outpatient rehab for addiction. 

On average, a 90-day program in an outpatient rehab facility costs about $5,000. While this is significantly less than inpatient, where the average is between $14,000 and $27,000 for a 30-day program, this amount of money can still overwhelm people. 

Outpatient rehab costs generally cover facilities, therapists, psychiatrists, other staff on hand, alternative therapies, amenities, meals, supplies, location, and time.

When referring to time, costs depend on whether the patient is going into a partial hospitalization program (PHP), where the patient attends most of the day for five days a week, or an intensive outpatient program (IOP), where the patient only attends for a few hours every few days.

Even though outpatient rehab is much less restrictive and intense, considerable costs still come into play.

Medicare coverage for outpatient rehab

Upon contacting an addiction rehab facility about their outpatient programs, prospective patients will go through a general consultation where they are asked questions and, in turn, can ask their own questions. Going over payment options is part of this process. Typically, outpatient rehab facilities accept most insurance companies and Medicare; some even have financing plans, although one company may be slightly different than another. Paying with cash is also an option, but many people cannot afford it and need to rely on their insurance or Medicare coverage to help with costs. 

Simply put, Medicare Part B covers outpatient rehab for addiction, but not all treatment facilities accept Medicare. 

According to Medicare experts, covered items and services for the treatment of alcoholism and substance use disorders include:

  • Psychotherapy
  • Patient education regarding diagnosis and treatment
  • Post-hospitalization follow-up
  • Out-patient prescription drugs through Medicare Part D
  • Inpatient prescription drugs, including Methadone
  • Structured Assessment and Brief Intervention (SBIRT)

Medicare Advantage offers even more coverage than the basic plan. 

There are some stipulations, such as:

“Partial hospitalization services must be provided under the direct supervision of a physician pursuant to an individualized treatment plan, and the services must be essential for treatment of the patient’s condition.”

If you have Medicare and want more specific details on what they cover and restrict, their website has excellent information. 

Conclusion

Thankfully, outpatient rehab facilities offer various payment options, with Medicare being one of them. That means even if you’re on a fixed income, you can still afford to get the help you need. And when it comes to addiction treatment, cost shouldn’t be a deterrent – remember that the costs of rehab always outweigh the costs of substance addiction. If you’re struggling with addiction and searching for an outpatient facility that accepts Medicare, look no further than Fusion Recovery. We offer comprehensive care at an affordable price, and we’ll work with you to create a payment plan that fits your budget. Contact us today for a consultation.

Contact us.

    Or Call us.

    Scroll to Top