Medicare And Substance Abuse Treatment [Guide]

Inpatient versus outpatient care

The Centers for Medicare & Medicaid Services (CMS) offers services that can help an individual recover from substance use disorder. Still, there is not a specific category or service that is targeted for substance use disorder.

When reasonable and necessary, determined by a qualifying practitioner, inpatient treatment is available and covered under Medicare. Medication that is provided during inpatient stay would be part of the inpatient payment and not paid separately.

There are many practitioners who would be authorized to determine whether an individual’s case was inpatient qualified. Physicians such as a medical doctor or a doctor of osteopathy, clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives are all authorized to decide. These inpatient services would all be a part of Medicare Part A.

Outpatient services fall under the Medicare Part B category. These services are on a case-by-case basis or as needed. Certain doctor visits and treatment is covered under this part of the coverage.

 Medicare Part B also covers medical supplies such as oxygen tanks, Continuous Positive Airway Pressure (CPAP) machines, canes, crutches, and body monitors. The medical supplies list made available under Medicare Part B coverage continues and is an enormous part of Medicare Part B utilization.

Outpatient services can also include psychologist or psychiatrist counseling, a powerful tool that is vastly underrated. Counseling is an efficient avenue for those who recognize substance use disorder in themselves. Counseling can begin to identify the origin of the individual’s substance use disorder.

Whether an individual chooses Medicare Part A, Medicare Part B, or both, cost efficiency is likely to play a role in deciding. Medicare Part A will help an individual who experiences frequent hospital visits or is prone to hospital admission. At the same time, Medicare Part B will aid individuals who are heavily reliant on medical supplies to survive.

When in doubt, contacting Medicare directly will answer any questions that may arise to give individuals information to make an educated decision.

Medicare and Substance Use Disorder

Elderly individuals can have an incredibly stressful experience in making medical decisions, especially if they are struggling with or are susceptible to substance use disorder. Although Medicare does not have a specified program for elderly individuals with substance use disorder, there are available options that are semi-customizable to fit the needs of the individual.

Treatment options are available, whether for inpatient care, outpatient care, or both. Elders do not need to be afraid of the cost of treatment, as Medicare has various plans that will fit even low-income budgets.
Whether an individual is automatically enrolled or is signing up for Medicare coverage, it is important to weigh the options to fit the patient’s needs.

If the individual is aware of a substance use disorder, speaking directly to a Medicare representative can help tailor a plan to treat the disorder with as little out of pocket as possible while still obtaining the necessary treatment.

Moving forward

Medicare is federal health insurance specifically for individuals sixty-five or older, for younger people who have specific disabilities, and for individuals who have permanent kidney failure that requires dialysis called End-Stage Renal Disease (ESRD). Medicare can automatically register and enroll some individuals, and some need to sign themselves up for coverage.

Medicare comes in multiple parts to expand coverage over specific frequencies such as doctor visits versus hospital stays. Medicare Part A is hospital insurance that covers inpatient stays to hospitals, nursing facilities or homes, hospice care, and even some home health care.

Medicare Part B is medical insurance that covers outpatient care such as certain doctor visits and medical supplies such as oxygen tanks, blood sugar monitors, canes, crutches, and CPAP machines.

 Medicare Part B also provides coverage for preventative services like lab tests and screenings. Medicare Part D is prescription insurance for pharmaceutical needs. This can help pay for monthly prescriptions and refills or pay for the prescription entirely.

Long-term use of certain prescription medications can cause dependency, addiction, or other serious health risks. These factors are especially difficult for people sixty-five and older to recover from due to the length of use.

 Elderly individuals are vulnerable to substance use disorders due to age, physical body limitations, and brain function. This makes dependency and addiction easier to develop and harder to wean off of.

Outpatient services and procedures are doctor visits, counseling sessions, and other medical appointments that allow the individual to return home or leave the building once complete. Inpatient services and procedures are hospital stays, nursing facility admissions, rehabilitation facilities, and other admissions that require overnight stays.

Medicare is an efficient insurance program that can offer treatment services to elderly individuals struggling with substance use disorder.