Medicare covers some drug and alcohol rehab, but not all types, and the coverage depends on which part of Medicare you have and whether you go to an inpatient or outpatient program.

Medicare Part A covers inpatient rehab stays in a hospital or skilled nursing facility if your doctor orders it as medically necessary. Medicare Part B covers outpatient rehab services, including counseling and medication-assisted treatment, when provided by a Medicare-enrolled provider. However, Medicare does not cover residential rehab facilities that are not hospitals or skilled nursing facilities, even if they provide medical care. The amount you pay out of pocket varies by program type and your specific plan.

The first step is to talk with your doctor about what type of rehab you need. Your doctor can tell you whether Medicare will cover it and refer you to a facility that accepts Medicare. If you are unsure whether a specific facility is covered, you can call Medicare directly at 1-800-MEDICARE or ask the facility's billing department to verify your coverage before you arrive.

Key Takeaways

  • Medicare Part A covers inpatient rehab in hospitals and skilled nursing facilities when your doctor says it is medically necessary.
  • Medicare Part B covers outpatient counseling, therapy, and medication-assisted treatment at Medicare-enrolled providers.
  • Medicare does not cover standalone residential rehab facilities, even if they have medical staff on site.
  • Your out-of-pocket costs depend on whether you choose inpatient or outpatient care and your specific Medicare plan.
  • Always verify coverage with the facility or Medicare before you start treatment, because some facilities do not accept Medicare.

What Medicare Part A Covers for Inpatient Rehab

Medicare Part A covers inpatient rehab stays in a hospital or a skilled nursing facility if your doctor determines it is medically necessary. This means you stay overnight and receive 24-hour medical supervision. The facility must be Medicare-certified, which you can check by calling the facility directly or asking your doctor.

To may have access to for Part A coverage, you typically must have been admitted to a hospital for at least three days before transferring to the rehab facility. The rehab stay must be for the same condition or a related condition that caused your hospital stay. Your doctor and the rehab facility's medical team will decide how long your stay should be.

For inpatient rehab under Part A, you pay a copay for each day of your stay. The copay amount changes each year. After you have paid a certain amount out of pocket, Medicare covers the rest of your inpatient stay for that benefit period. Ask the facility's billing department what your specific copay will be based on your coverage dates.

What Medicare Part B Covers for Outpatient Treatment

Medicare Part B covers outpatient rehab services, including individual and group counseling, therapy, and medication-assisted treatment when provided by a Medicare-enrolled provider. Outpatient means you do not stay overnight — you go to appointments and return home. These services can happen at a hospital outpatient department, a community mental health center, or a private practice that accepts Medicare.

Part B covers mental health and substance use disorder treatment the same way it covers other medical services. You pay a copay or coinsurance (usually 20 percent of the cost after you meet your deductible) for each visit. The number of visits Medicare covers is not limited, but your doctor must order the treatment and the provider must be Medicare-enrolled.

Medication-assisted treatment — such as methadone or buprenorphine for opioid use disorder — is covered under Part B when prescribed by a Medicare-enrolled doctor or nurse practitioner. You pay the same copay or coinsurance as for other Part B services. Some Medicare Advantage plans may have different rules, so check your plan documents or call your plan's customer service line.

What Medicare Does Not Cover

Medicare does not cover residential rehab facilities that are not hospitals or skilled nursing facilities. This includes private rehab centers, recovery houses, and sober living homes, even if they have doctors or nurses on staff. These facilities are considered room and board rather than medical care, so Medicare treats them as housing, not health care.

Medicare also does not cover rehab services from providers who are not Medicare-enrolled. Before you start treatment, always ask the provider whether they accept Medicare. Some facilities accept Medicare for inpatient stays but not for outpatient follow-up, or vice versa.

If you have a Medicare Advantage plan (Part C), your coverage may be different from Original Medicare. Some Advantage plans cover residential rehab through partnerships with specific facilities, while others do not. Check your plan's coverage details or call your plan's customer service number to find out what is covered under your specific plan.

How to Find a Medicare-Covered Rehab Facility

Start by talking with your primary care doctor or a mental health provider. They can refer you to a facility that accepts Medicare and is appropriate for your needs. Your doctor can also help determine whether you need inpatient or outpatient care.

You can search for Medicare-certified facilities using the Care Compare tool on Medicare.gov. Enter your location and select "Skilled Nursing Facilities" or search for "substance use disorder treatment" to find outpatient providers. The search results show which facilities are Medicare-certified and their contact information.

Call the facility directly and ask whether they accept Medicare. Ask what your out-of-pocket cost will be and whether they can verify your coverage before you arrive. Some facilities have financial counselors who can walk you through your costs and payment options. If a facility does not accept Medicare, ask your doctor for another referral.

Out-of-Pocket Costs for Inpatient and Outpatient Care

For inpatient rehab under Medicare Part A, you pay a daily copay for days 1 through 60 of your stay in a benefit period. Days 61 through 90 have a higher copay. After day 90, you pay all costs until your benefit period ends. The exact copay amounts change each year, so ask your facility what you will owe based on your admission date.

For outpatient services under Medicare Part B, you pay 20 percent coinsurance after you meet your annual deductible. If you see a provider who does not accept Medicare assignment, you may owe more. Always ask whether the provider accepts assignment before your first visit.

If you have a Medigap or Medicaid policy in addition to Medicare, it may cover some of your out-of-pocket costs. Contact your supplemental insurance provider to find out what they cover for rehab services.

What to Do If Medicare Denies Coverage

If Medicare denies coverage for a rehab stay or service, the provider or facility must give you a written notice explaining why. The notice will tell you how to file an appeal. You have the right to request a review of the denial.

If you disagree with the denial, you can file an appeal through Medicare. The process has several levels: reconsideration, hearing before an administrative law judge, and further review. Your doctor can help support your appeal by providing medical records showing that the treatment was necessary.

Some facilities have patient advocates or social workers who can help you understand a denial and prepare an appeal. You can also call 1-800-MEDICARE to ask questions about a denial or get help filing an appeal.

Frequently Asked Questions

Does Medicare cover detox?

Yes, if detox is provided in a hospital or skilled nursing facility as inpatient care ordered by your doctor. Medicare Part A covers the inpatient stay. Outpatient detox services are covered under Part B when provided by a Medicare-enrolled provider. Detox at a standalone facility that is not a hospital is not covered.

Will Medicare cover rehab if I do not have a hospital stay first?

Medicare Part A usually requires a three-day hospital stay before covering inpatient rehab in a skilled nursing facility. However, outpatient rehab services under Part B do not require a prior hospital stay. Talk with your doctor about whether outpatient treatment would work for your situation.

Does Medicare Advantage cover rehab differently than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but some plans offer additional coverage for residential rehab or more outpatient visits. Check your plan's coverage details or call your plan's customer service line to find out what is covered under your specific plan.

What if I cannot afford the out-of-pocket costs?

If you have limited income, you may be able to get help paying your costs through Medicaid, the Medicare Savings Program, or other state programs. Contact your local Medicaid office or call 1-800-MEDICARE to ask about programs that help with costs.

Can I use my Medicare to go to any rehab facility I choose?

No. The facility must be Medicare-certified and accept Medicare. Not all rehab facilities do. Your doctor can help you find a facility that accepts Medicare and is appropriate for your needs. Always verify coverage before you arrive.