Medicare covers some drug and alcohol rehab, but not all types, and the amount depends on which part of Medicare you have and the type of treatment facility.
Medicare Part A covers inpatient rehab stays in hospitals and may have access to rehabilitation facilities — places that meet Medicare's standards for medical care and staffing. You pay a copay per day (the amount changes yearly), and Medicare covers the rest after you meet your deductible. Part B covers outpatient rehab, counseling, and some medications, though you typically pay 20 percent of the cost after your deductible.
Medicare does not cover all rehab programs. It will not pay for stays in non-medical facilities, luxury rehab centers, or programs that do not have a doctor on staff. It also does not cover rehab that happens in a regular nursing home unless that home is certified as a rehabilitation facility. The key difference is medical supervision — if a facility is primarily social support or peer counseling without a physician directing your care, Medicare will not cover it.
Key Takeaways
- Medicare Part A covers inpatient rehab in hospitals and may have access to rehabilitation facilities after a may have access to hospital stay of at least three days.
- Medicare Part B covers outpatient counseling, therapy, and some medications for substance use disorder at 80 percent after you meet your deductible.
- Your facility must have a doctor on staff and be certified by Medicare — many private or luxury rehab centers do not meet these standards.
- You can call 1-800-MEDICARE to confirm whether a specific facility is Medicare-certified before you check in.
How Medicare Part A Covers Inpatient Rehab
If you need to stay overnight in a rehab facility, Medicare Part A will cover it if three conditions are met: you spent at least three consecutive days in a hospital when ready before the rehab stay, your doctor says the rehab is medically necessary, and the facility is Medicare-certified as a rehabilitation hospital or skilled nursing facility with a rehabilitation unit.
You pay a daily copay for days 1 through 20 (the amount varies by year), and Medicare covers 100 percent of days 21 through 100. After day 100 in a benefit period, you pay all costs. A benefit period starts the day you enter the hospital and ends 60 days after you leave the hospital or rehab facility with no hospital or skilled nursing stays in between.
The three-day hospital stay rule is strict. If you were admitted to the hospital for observation only — meaning you were not formally admitted as an inpatient — those days do not count. Ask the hospital billing department whether you were admitted as an inpatient or held for observation; this determines whether you may have access to for Part A rehab coverage.
How Medicare Part B Covers Outpatient Treatment
Medicare Part B covers outpatient rehab services including individual and group counseling, therapy sessions, and psychiatric care related to substance use disorder. You pay 20 percent of the cost after you meet your annual Part B deductible; Medicare pays 80 percent. There is no limit on the number of sessions Medicare will cover, as long as your doctor says they are medically necessary.
Part B also covers medications used to treat opioid use disorder, including methadone, buprenorphine, and naltrexone, when prescribed by a doctor. Some medications require prior authorization from Medicare before the pharmacy fills them, so ask your doctor or pharmacist whether your specific medication needs approval first.
Outpatient rehab can happen at a hospital outpatient department, a community mental health center, a doctor's office, or a telehealth visit. The provider must accept Medicare and be enrolled in the program. You can search for Medicare-enrolled providers on the Medicare provider search tool at Medicare.gov.
What Medicare Does Not Cover
Medicare does not cover rehab in facilities that are not medically supervised. This includes sober living homes, peer support houses, and recovery residences — even if they have counselors on staff. These facilities focus on social support and accountability rather than medical treatment, which is why Medicare excludes them.
Luxury or specialty rehab programs that do not meet Medicare's medical standards are also not covered. Some high-end facilities market themselves as rehab but operate more like hotels with counseling services. If a facility advertises amenities like spa services, gourmet meals, or private rooms as part of the rehab package, it may not be Medicare-certified.
Medicare also does not cover rehab in a regular nursing home unless that home has a specific Medicare-certified rehabilitation unit with a physician director. A nursing home that provides general care is different from one that provides acute rehabilitation. Ask the facility directly whether it is Medicare-certified for rehabilitation services.
How to Find a Medicare-Certified Rehab Facility
The fastest way to confirm a facility is Medicare-certified is to call 1-800-MEDICARE (1-800-633-4227). Tell them the name and location of the facility, and they will tell you whether it meets Medicare standards for coverage. You can also search the Medicare Care Compare tool at Medicare.gov, which lists hospitals and rehabilitation facilities by location and shows which ones are certified.
When you call a rehab facility directly, ask whether they are Medicare-certified and whether they accept your specific Medicare plan. Some facilities accept Original Medicare (Part A and B) but not Medicare Advantage plans, or vice versa. Confirm this before you schedule an intake appointment.
If you have a Medicare Advantage plan (Part C), your coverage may differ from Original Medicare. Some Advantage plans cover additional rehab services that Original Medicare does not, or they may have a different list of in-network facilities. Call your Advantage plan's customer service number to ask what rehab coverage is included in your specific plan.
What Happens After Rehab: Continuing Care
After you leave inpatient rehab, Medicare Part B continues to cover outpatient follow-up care — counseling sessions, therapy, and medications — for as long as your doctor says they are medically necessary. This is often the most important part of recovery, and Medicare does not limit the number of sessions.
If you need to return to inpatient rehab later, you must meet the three-day hospital stay requirement again. You cannot go directly from one rehab facility to another and have Part A cover the second stay; you need a hospital admission in between.
Medicare Advantage Plans and Rehab Coverage
If you have a Medicare Advantage plan, your rehab coverage works differently than Original Medicare. Advantage plans must cover at least what Original Medicare covers, but many offer additional services. Some Advantage plans cover sober living homes, peer support programs, or extended outpatient counseling that Original Medicare does not.
Your Advantage plan may also have different copays, deductibles, or out-of-pocket limits for rehab services. Call your plan's customer service line before you enter rehab to understand your costs. Ask specifically whether the facility you are considering is in-network and what your copay will be for each day of inpatient care or each outpatient visit.
Frequently Asked Questions
Do I need my doctor's referral to go to rehab?
For Medicare to cover inpatient rehab, your doctor must say it is medically necessary and refer you to a Medicare-certified facility. For outpatient services, you need a doctor's order. You can seek rehab on your own, but Medicare will not cover it without a physician's involvement.
What if I was in the hospital for observation, not admitted as an inpatient?
Observation days do not count toward the three-day requirement for Part A rehab coverage. Ask the hospital to change your status to inpatient admission if possible, or you may need to pay out of pocket for rehab or use Part B outpatient services instead. This is worth clarifying before you leave the hospital.
Does Medicare cover rehab for alcohol use disorder?
Yes. Medicare covers inpatient and outpatient rehab for alcohol use disorder under the same rules as opioid or drug use disorder. The facility must be Medicare-certified, and inpatient stays must follow a three-day hospital admission.
Can I use my Medicare Advantage plan at any rehab facility?
No. Most Advantage plans have a network of in-network facilities where your copay is lower. Using an out-of-network facility usually costs you more. Call your plan before you choose a facility to confirm it is in-network and what your costs will be.
What if I cannot afford the copays for inpatient rehab?
If cost is a barrier, ask the rehab facility's financial counselor about payment plans or sliding scale fees. Some facilities work with patients on copay amounts. You can also ask your doctor about outpatient rehab instead, which may have lower out-of-pocket costs under Part B.