Medicare & Addiction Treatment
Medicare covers a broad range of substance use disorder services through Parts A, B, and D. Here is what each part covers, what it costs, and what to expect.
Medicare is available to people 65 and older, those under 65 with certain disabilities, and people with end-stage renal disease. If you qualify, Medicare can significantly reduce your rehab costs.
Questions? Call 1-800-MEDICARE (1-800-633-4227) or SAMHSA at 1-800-662-4357.
Medicare at a Glance
Inpatient hospital, inpatient psychiatric, skilled nursing
Outpatient counseling, office-based MAT, screenings
Buprenorphine, naltrexone, and other addiction medications
Part AInpatient Addiction Treatment
Medicare Part A covers inpatient hospital stays related to substance use disorder, including medically supervised detoxification and inpatient psychiatric treatment when a physician certifies the medical necessity. Part A does not cover freestanding residential rehab facilities unless they are Medicare-certified hospitals or psychiatric units.
What Part A Covers for Addiction
- ✓Medically necessary inpatient hospital detoxification (alcohol, opioids, sedatives)
- ✓Inpatient psychiatric care for co-occurring mental health disorders
- ✓Semi-private room, meals, nursing care, and medications administered during the stay
- ✓Inpatient mental health care in a specialty psychiatric hospital (190-day lifetime limit)
- ✓Care in a skilled nursing facility (SNF) following a qualifying hospital stay of 3+ days
Part A Costs (2025)
| Hospital Stay Length | Your Cost |
|---|---|
| Days 1–60 | $1,632 deductible total (not per day) |
| Days 61–90 | $408 per day co-insurance |
| Days 91–150 (Lifetime Reserve) | $816 per day co-insurance |
| Beyond 150 days | You pay all costs |
Figures are approximate 2025 standard Medicare amounts and subject to annual adjustment.
Part BOutpatient Addiction Treatment
Medicare Part B covers outpatient substance use disorder treatment and is typically where most ongoing addiction care takes place after an initial inpatient stay. Part B also covers annual depression screenings and brief alcohol misuse counseling in primary care settings at no cost to you.
What Part B Covers for Addiction
- ✓Individual and group outpatient counseling and psychotherapy
- ✓Intensive Outpatient Programs (IOP) at Medicare-certified facilities
- ✓Partial Hospitalization Programs (PHP) — up to 6 hours per day when medically necessary
- ✓Physician office visits for addiction evaluation and MAT management
- ✓Annual alcohol misuse screening and up to 4 brief counseling sessions per year at zero cost
- ✓Annual depression screening at zero cost
- ✓Opioid treatment programs (OTPs) — bundled payment covers counseling, toxicology tests, and medication
Part B Costs (2025)
| Service | Your Cost |
|---|---|
| Part B monthly premium | ~$185/month (income-based) |
| Annual deductible | ~$257 per year |
| Outpatient mental health / SUD counseling | 20% of the Medicare-approved amount after deductible |
| Partial Hospitalization Program (PHP) | 20% co-insurance after deductible |
| Opioid Treatment Program (bundled) | 20% co-insurance; no deductible for OTP |
| Alcohol misuse screening + counseling | $0 (preventive benefit, no cost sharing) |
Medigap (Medicare Supplement) plans can cover the 20% co-insurance, reducing your out-of-pocket costs significantly.
Part DAddiction Medications (Prescription Drug Coverage)
Medicare Part D prescription drug plans cover FDA-approved medications used in addiction treatment. All Part D plans are required to cover at least two drugs in each therapeutic category, and for opioid use disorder medications specifically, CMS has guidance encouraging broad access.
Key Medications Covered
Buprenorphine
(Suboxone, Subutex, Sublocade)
Opioid use disorder — reduces cravings and withdrawal
Most Part D plans cover at least one formulation on formulary
Naltrexone
(Vivitrol — injectable)
Opioid and alcohol use disorder — blocks opioid receptors
Injectable form widely covered; oral form varies by plan
Acamprosate
(Campral)
Alcohol use disorder — reduces cravings during early recovery
Generally covered under Part D formularies
Note on methadone: Methadone for opioid use disorder is dispensed only through federally certified Opioid Treatment Programs (OTPs). When received through an OTP, it is covered under Part B as part of the bundled OTP benefit — not Part D. Methadone for pain management is covered under Part D.
Medicare Advantage (Part C)
Medicare Advantage plans (offered by private insurers) must cover all services that Original Medicare covers, including SUD treatment. Many Advantage plans offer additional benefits beyond Original Medicare, such as lower co-pays for outpatient therapy or coverage of some residential treatment programs.
However, Advantage plans use networks — you must use in-network providers to get the plan rate. Always confirm that a specific rehab facility participates in your Advantage plan's network before admission.
Tips for Using Medicare for Addiction Treatment
Verify Medicare certification
Not all rehab facilities are certified to bill Medicare. Always confirm the facility accepts Medicare before admission.
Get a physician referral
Most Medicare-covered SUD services require a physician's order or referral. Your primary care doctor can help initiate the process.
Consider Medigap for cost protection
A Medigap supplement plan can cover the 20% Part B co-insurance and Part A deductibles, dramatically reducing your out-of-pocket exposure.
Look into Medicare Savings Programs
If your income is limited, state Medicare Savings Programs can pay your Part B premiums and cost-sharing. Contact your State Health Insurance Assistance Program (SHIP).
Use the free SHIP counseling service
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. Call 1-800-Medicare to find your local SHIP.
Medicare coverage details, premiums, deductibles, and co-insurance amounts are updated annually by the Centers for Medicare & Medicaid Services (CMS) and may differ from the figures shown here. The information on this page is for educational purposes only. Always verify your specific benefits at medicare.gov or by calling 1-800-633-4227.