Recovery from a drug addiction can be an intense process that requires a team of healthcare professionals for support. Medicare recipients may have coverage options before, during, and after drug rehabilitation.
When Drug Rehab Is Necessary
Issues with substance abuse may not be apparent in their earliest stages. During the initial phases of addiction, a person is typically able to exert control over their habits and maintain functional behavior. This means they can still perform work, socialize and take care of themselves and their family.
As addiction intensifies, however, the person loses the ability to control their use. As their function deteriorates, they may miss days at work, behave erratically, withdraw from others and show disinterest in participating with normal daily activities.
Ideally, a healthy and balanced lifestyle includes no substance abuse whatsoever — which means any substance abuse may warrant formal drug rehabilitation to treat it. A robust support system is necessary with advanced addiction. With some substances, quitting abruptly can cause life-threatening side effects.
Physical dependency on these substances complicates a person’s ability to stop using them. Shivers, seizures, hallucinations and other side effects may occur during detox. Patients should be monitored closely by trained healthcare professionals during this process and may need to take certain medications to help alleviate symptoms associated with their detox.
Different Types of Drug Rehab
Rehab programs may be classified in a variety of ways, but they typically function through four main practices:
- Residential treatment. These programs can be long or short-term at inpatient facilities or in non-hospital therapeutic communities. Long-term treatment may be 6-12 months, while short-term programs last several weeks. They are best suited for people in need of around-the-clock observation and medication-managed withdrawal. Daily activities are typically very structured and include goal-setting and counseling.
- Outpatient programs. Medication-managed withdrawal can also take place for people in outpatient programs, though usually only if they have a strong personal support system in place. While this style of treatment may be considered low-intensity, it can help patients prevent job loss due to treatment and reduce the costs associated with receiving treatment.
- Individual counseling. While counseling may be a part of any rehabilitation program, it can also serve as a primary preventive step for people who may be in the early stages of addiction or trying to avoid a relapse during recovery. Drug counseling in a one-on-one setting focuses on strengthening coping skills and identifying achievable goals while in recovery.
- Group counseling. This style of counseling is also often part of other treatment programs, but on its own can provide peer support and access to resources that help patients with their recovery. Continuing group counseling sessions may be a recommended step after other treatment programs have been completed.
Medicare Coverage for Drug Rehab
Medicare recipients who require rehabilitation for drug use may need to provide certain documentation in order for their Medicare coverage to apply. Their provider may need to show the patient has a medical necessity for drug rehab as well as create their care plan while in treatment. Additionally, the rehabilitation provider and facility must meet Medicare approval.
Medicare Part A is used for inpatient hospital stays, but may have lifetime limits for how many days it covers. Outpatient treatment is covered through Medicare Part B. Cost-sharing obligations, such as deductibles and coinsurance amounts, will depend on which type of treatment program is used.
Medication administered in an inpatient setting falls under Part A coverage rules. Outpatient facilities may provide medication or may write a prescription for medication to take at home. Typically, medication administered on-site in an outpatient setting will be covered under Part B policy provisions, but it may exclude certain drugs used to treat substance abuse.
The same is true for Medicare’s Part D Prescription Drug Plan or prescription coverage with a Medicare Advantage plan. A plan’s formulary and coverage rules will provide details on which medications are covered and under which circumstances the coverage can occur.
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