Does Medicare Cover Substance Abuse Treatment in Michigan?

Addiction doesn’t stop at retirement age for our seniors in the state. Recent studies show that nearly 1 in 11 adults over 60 years of age struggles with substance abuse, whether it’s alcohol, prescription medications, or other substances. The silver lining? Medicare recognizes substance abuse as a legitimate medical condition and covers a wide range of treatment options.

Medicare can help cover the costs of drug and alcohol rehabilitation. However, there are specific rules regarding which providers are eligible under Medicare. Additionally, some types of addiction treatment may not be covered.

Understanding Medicare Coverage for Addiction Treatment in Michigan

Understanding Medicare’s different parts is crucial because each one covers different aspects of your treatment process.

Medicare Part A (Hospital Insurance)

Covers inpatient detoxification and rehabilitation programs when they’re medically necessary. This includes hospital stays for withdrawal management and residential treatment programs that meet Medicare standards. 

Under Part A, an individual is limited to a total of 190 days of treatment at specialty care facilities over their lifetime. This lifetime cap covers services received at:

• Acute care hospitals
  
  
• Critical access hospitals
  
  
• Inpatient rehabilitation centers
  
  
• Long-term care hospitals
  
  
• Inpatient care during qualifying research studies
  
  
• Mental health treatment facilities

Medicare Part B (Medical Insurance) 

It is where most ongoing treatment happens. It covers outpatient counseling sessions, group therapy, intensive outpatient programs, and mental health services related to substance abuse. 

Medicare Part D (Prescription Drug Coverage) 

Covers medications used in addiction treatment, including buprenorphine (Suboxone) and naltrexone (Vivitrol). Interestingly, methadone dispensed at specialized opioid treatment programs falls under Part B coverage instead of Part D.

What Treatment Options Are Actually Covered?

The overall scope of covered treatments might surprise you. For inpatient care, Medicare covers medical detoxification when withdrawal could be dangerous to your health. This is especially important for alcohol or benzodiazepine withdrawal, which can be life-threatening without medical supervision.

When it comes to outpatient services, it offers tremendous flexibility. Medicare covers individual therapy sessions with licensed addiction counselors, group therapy programs, intensive outpatient programs (IOPs), and partial hospitalization programs for more intensive daily treatment. Family counseling is also covered when it’s directly related to the patient’s treatment plan.

Medication-assisted treatment (MAT) has revolutionized addiction recovery, particularly for opioid use disorders. Medicare covers the medications that make MAT possible, including buprenorphine for opioid addiction and naltrexone for both opioid and alcohol addiction. The counseling and monitoring that accompany these medications are also covered benefits.

Understanding the Requirements and Limitations

While Medicare coverage is comprehensive, there are some important requirements to keep in mind. 

All services must be deemed “medically necessary” by a healthcare provider. This means your doctor needs to document why specific treatments are appropriate for your condition. This is standard practice, and most medical doctors understand this.

Most importantly, you must use Medicare-approved providers. Not every treatment center accepts Medicare, so it’s essential to verify coverage before starting any program. Many of you have a Medicare Advantage plan, so you’ll also need to ensure providers are in your plan’s network.

Lastly, prior authorization may be required for certain services, particularly extended inpatient stays. While this might seem like a hurdle, it’s typically just paperwork that your doctor’s office handles. Starting the process early helps prevent treatment delays.

What You Can Expect to Pay

Let’s talk about the financial reality of addiction treatment under Medicare. For inpatient care, you’ll pay the Part A deductible upfront ($1676.00 – 2025’), then nothing for the first 60 days of treatment. For outpatient services, you’ll need to meet your Part B deductible ($257.00 – 2025’)  first, then pay 20% of Medicare-approved amounts.

With regards to Part D, prescription medication costs vary widely depending on your specific Part D plan. Generic versions of addiction medications like buprenorphine might cost $10-30 per month, while brand-name options could be $50-150 monthly, depending on your plan’s formulary.

Having a Medicare Supplement (Medigap) policy can significantly reduce your out-of-pocket costs by covering the 20% coinsurance and deductibles that Original Medicare doesn’t pay.

If you currently have a Medicare Advantage plan, it is important to verify your substance abuse benefits directly with your insurance provider.

How to Find and Access Covered Services

The Medicare.gov website has a provider directory where you can search specifically for addiction treatment services in your area. When calling potential providers, always ask them to verify your Medicare coverage before scheduling your first appointment.

Your primary care physician can be an excellent starting point. They can provide referrals to addiction specialists and help coordinate your care. Many people find this less overwhelming than trying to navigate the system independently.

Don’t overlook community health centers, which often have sliding fee scales and accept Medicare. These centers frequently offer comprehensive addiction services, including counseling, medication management, and support groups.

Resources and Next Steps

If you are considering treatment, start by calling your doctor or a Medicare-approved addiction treatment provider. For immediate help finding resources, contact SAMHSA’s National Helpline at 1-800-662-4357, which provides free, confidential treatment referrals 24/7.

Additionally, Michigan residents can also find support through the Health & Human Services page: https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/drugcontrol/treatment and CARE of Southeastern Michigan’s resources for aging adults facing substance abuse: https://www.careofsem.com/aging-substance-abuse/.

For specific questions about your Medicare coverage, reach out to our agency so we can help you navigate any concerns you may have. We can explain your benefits and answer any questions you may have.

At the end of the day, Medicare for our seniors here in Michigan is designed to support your recovery journey. With proper planning and understanding of your benefits, you can focus on your health.

Resources:

• APA | https://www.apa.org/monitor/2025/01/substance-misuse-older-adults
• Drug Rehab USA | https://drugrehabus.org/does-medicare-cover-rehab/

Healthline | https://www.healthline.com/health/medicare/medicare-substance-abuse-treatment