Substance use disorders are common among older adults, and they can be harder to spot. Medicare has expanded addiction coverage in recent years. Here's how each part works and how to find a program that accepts your coverage.
What does each part of Medicare cover?
Medicare has several parts, and each one pays for a different piece of addiction care.
| Medicare part | What it generally covers for substance use treatment |
|---|---|
| Part A (hospital) | Inpatient hospital care, including medically managed withdrawal and psychiatric hospital stays |
| Part B (medical) | Outpatient counseling, partial hospitalization, intensive outpatient programs, opioid treatment programs, screenings |
| Part D (drugs) | Many prescription medications for alcohol and opioid use disorder |
| Medicare Advantage (Part C) | Everything Original Medicare covers, through a private plan, often with networks and extra rules |
All coverage requires that the care be medically necessary and delivered by a provider that accepts Medicare.
Medical detox matters. Withdrawal from alcohol or benzodiazepines can be life-threatening, especially for older adults with other health conditions. It should always be medically supervised. If someone is in danger, call 911.
Have questions about your Medicare benefits? Call (877) 847-2855 to talk through options and check your coverage. It's free and confidential.
What does Medicare Part A cover?
Part A pays for inpatient care in a general hospital or psychiatric hospital. That can include hospital inpatient treatment and medically supervised detox when you need round-the-clock medical care.
Part A has a deductible for each benefit period. Stays in a freestanding psychiatric hospital also have a lifetime limit. Original Medicare generally does not pay for stays at non-hospital residential rehab programs, which is the setting many private rehabs use.
What does Medicare Part B cover?
Part B covers most outpatient addiction treatment. After you meet the yearly deductible, you usually pay coinsurance for covered services.
- Outpatient therapy and counseling with psychiatrists, psychologists, clinical social workers and other approved providers.
- Partial hospitalization (PHP). A structured day program, usually several hours a day, for people who need intensive care but not a hospital bed. Learn more about PHP.
- Intensive outpatient programs (IOP). Medicare began covering IOP services in 2024. IOP is a step down from PHP, usually with several sessions a week. Read about IOP.
- Opioid treatment programs (OTPs). Since 2020, Part B has covered OTP services. That includes methadone, buprenorphine and naltrexone, along with counseling, drug testing and treatment planning. See methadone clinics.
- Screening and brief intervention for alcohol misuse in primary care.
- Telehealth for many behavioral health services. Find out about telehealth treatment.
What does Medicare Part D cover?
Part D plans cover many medications used in medication-assisted treatment (MAT). MAT combines medicine with counseling. Covered drugs may include buprenorphine products for opioid use disorder and medications for alcohol use disorder.
Each Part D plan has its own drug list, called a formulary, plus copays and possible prior authorization. Methadone for opioid use disorder is only given through certified OTPs, so it is covered under Part B, not Part D.
How does Medicare Advantage handle rehab?
Medicare Advantage plans are offered by private insurers approved by Medicare. They must cover at least what Original Medicare covers, but they work differently:
- Many use HMO or PPO networks, so going out of network can cost more or not be covered.
- Many require prior authorization for inpatient care, PHP and other higher levels of care.
- Some offer extra benefits, and some may cover settings Original Medicare does not.
Call the number on your plan card and ask what's covered at each level of care.
How do you find rehab programs that accept Medicare?
Many private rehabs don't accept Medicare. These steps can help you find one that does:
- Confirm your coverage type. Original Medicare, Medicare Advantage, or both Medicare and Medicaid.
- Look for Medicare-enrolled providers. Hospitals, community mental health centers, OTPs and many outpatient clinics accept Medicare.
- Ask about the level of care. Make sure the program offers a level of care Medicare covers.
- Consider programs for older adults. Some programs specialize in treatment for seniors, which can address medications, chronic illness and isolation.
- Filter by state. Try pages like Florida programs that accept Medicare or California programs that accept Medicare.
If you also qualify for Medicaid, it may help pay costs that Medicare leaves behind.
The bottom line
Medicare covers more addiction treatment today than it used to, from detox in the hospital to IOP and methadone. The key is matching the level of care to a provider that accepts your plan. Use the directory below to find programs by state, or call (877) 847-2855 and our admissions helpline can help you check your Medicare benefits. If you are in crisis, call or text 988.
