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Medicare and Medicaid Alcohol Rehab Programs: What They Cover and Entail

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Does Medicaid cover alcohol rehab? Does Medicare cover alcohol rehab? These are great questions. Medicaid and Medicare are government programs established to assist and insure Americans. Medicaid is an assistance program offered to persons below a certain income, and Medicaid alcohol rehab may be included. Medicare is an insurance program for someone over 65 and does not use income alone as a determinant. If you are under 65 and have a disability, you may also qualify for Medicare alcohol rehab. It is possible to be eligible for and receive both coverages.1

Impact of the Affordable Care Act on Alcohol Rehab

The Affordable Care Act (ACA) made changes to Medicaid and Medicare, intending to increase the number of Americans who have insurance. It allows young adults to stay on their parent’s insurance until age 26 and prevents anyone with pre-existing conditions from a health insurance denial. The ACA also expanded income eligibility requirements based on the federal poverty level. The expansions have helped millions of people qualify for Medicaid alcohol rehab, Medicare, and other health insurance plans through the government’s healthcare marketplace.2

Who Qualifies for Medicaid Alcohol Rehab?

Medicaid is a health insurance program for adults over 18, and the Children’s Health Insurance Program (CHIP) is for anyone under 18 who meets specific criteria. Medicaid is a joint funding program between the federal government and the state in which you live. Therefore, eligibility criteria may vary per state.3

The most recent data reports reveal close to 80 million adults and nearly 7 million children are receiving Medicaid alcohol rehab benefits across the United States.3

Eligibility requirements are based on:4

  • Income-based on the modified adjusted gross income (MAGI)
  • Household size
  • Disability
  • Family status
  • Other factors determined by each state
  • Participation in certain programs like foster care and SSI
  • S. citizenship or qualified alien

States can choose to be flexible with the Medicaid alcohol rehab options they provide to certain eligibility groups, such as:5

  • Low-income children
  • Children in the welfare system
  • Pregnant women, low-income or non-low-income
  • Caretaker relatives
  • Adults without dependents
  • Non-citizens
  • Medically needy

These requirements will vary depending on individual states and changes they have implemented regarding Medicaid alcohol rehab in recent years.

Medicaid Expansion

All but 12 states expanded benefits to cover all families with incomes below a certain level. For many of these states, you can qualify for Medicaid based on your income alone. They calculate income using MAGI and a percentage of the federal poverty level. For example, Colorado adults are eligible for Medicaid if their income is 138% of the federal poverty level. Alabama has not yet adopted alcohol rehab Medicaid expansion benefits, however.6

For states like Colorado, using the 138% of the federal poverty level requirement, income ranges will resemble the following:7

  • A family size of 1 is $17,774.
  • A family size of 2 is $24,040.
  • A family size of 3 is $30,305.
  • A family size of 4 is $36,570.

What Is Covered in a Medicaid Alcohol Rehab?

Each state is required to provide minimum substance use disorder coverage. However, they can add to the list of coverages and inclusions if they choose. The Medicaid alcohol rehab services must be a medical necessity, typically a life-saving service like inpatient treatment to treat alcohol toxicity.8

All states have the option to provide much-needed Medicaid alcohol rehab services to enrollees with behavioral health issues. Often called the rehabilitative state plan benefit or rehab option for short, they can provide any or all of the following:8

  • Therapy or counseling with licensed providers
  • Recovery support groups
  • Life skills training
  • Relapse prevention and early recovery skills
  • Employment training
  • Medication-assisted treatment (MAT)
  • Inpatient and outpatient detoxification
  • Partial hospitalization programs
  • Intensive outpatient programs
  • Inpatient residential programs

How Do ACA Healthcare Plans Cover Alcohol Rehab?

If you do not meet the eligibility criteria for Medicaid, you can still obtain healthcare coverage at affordable costs, even if you have pre-existing conditions. You can choose between health management organizations (HMOs) or preferred provider organizations (PPOs). Both types of insurance offer low copayments but limit where you can receive Medicaid alcohol rehab services, especially HMOs, which are less flexible than PPOs.9

Insurance plans are purchased on the health insurance marketplace online. The plans split costs with you based on the details of your agreement. Plans range from Platinum to bronze, with Platinum covering the most significant percentage of costs, typically 90%, and bronze at 60%. Services for the Medicaid alcohol rehab covered will vary based on state requirements but are similar to alcohol rehab Medicaid benefits.9

Who Qualifies for Medicare Alcohol Rehab?

Medicare is available for Americans who are 65 or older, but several factors expand eligibility to other groups, including:10

  • U.S. citizens
  • Documented immigrants living in the U.S. for at least five years
  • Disability recipients under 65 receiving benefits for at least two years
  • Medicare-covered government employees and spouses
  • End-stage renal disease, Lou Gehrig’s disease, or other terminal conditions
  • Recipient of pension disability from the Railroad Retirement Board

If you do not qualify based on these requirements, you can buy into the program and pay affordable premiums to receive health insurance coverage. You can also purchase various Medicare add-on coverages to supplement your base plan. You likely have questions like, “Does Medicare cover alcohol rehab?” The answers below apply to behavioral health and substance misuse treatment.

Alcohol Rehab Medicare Part A

Medicare Part A covers inpatient alcohol rehab Medicare. You must first qualify for inpatient stay by meeting both of the following:11

  • The inpatient rehab accepts Medicare
  • A doctor’s order stating inpatient treatment is medically necessary

When you enter inpatient Medicare alcohol rehab, you will have to pay the deductibles and copays that resemble other insurance plans. Services covered in Medicare alcohol rehab include the following:11

  • Semi-private hospital room
  • Nursing care
  • Medications prescribed by a physician
  • Supplies and equipment needed to provide treatment services
  • Meals
  • Rehabilitation services, including psychotherapy and support groups

Medicare pays for early intervention services for substance use disorders. Recognizing and getting help early can prevent longer-term consequences of alcohol misuse. The structured assessment and brief intervention (SBRIT) assess you to see if you are showing signs of alcohol misuse before developing into a diagnosable disorder. There are three steps to this approach:11

  • Screening and assessment provided by licensed professionals in an outpatient clinical setting to measure alcohol misuse and if it correlates with risky behaviors
  • Brief intervention methods help you understand how alcohol is affecting your life and that getting treatment now could prevent an alcohol use disorder
  • Referrals are given for anyone who engages and wants to learn more on how to prevent an alcohol use disorder

Medicare Part A will pay for inpatient Medicare alcohol rehab services for up to 190 days, but only one time, at a specialty hospital. There is no limit to days for treatment at a general hospital.11

Alcohol Rehab Medicare Part B

Medicare Part B covers medical services provided on an outpatient basis at an outpatient hospital or treatment center. Services covered include:11

  • Partial-hospitalization programs
  • Intensive outpatient programs
  • Individual and group therapy with licensed providers
  • Alcohol screenings and evaluations
  • Medications

Alcohol Rehab Medicare Part C

Medicare Part C is also called the Medicare Advantage Plan. You can choose to get this plan instead of the original Medicare parts A and B. It offers the same coverage as the original but can have different rules, costs, and restrictions. There are many kinds of alcohol rehab Medicare Part C plans to choose from, and you can include Medicare Part D in any of your packages.11

Alcohol Rehab Medicare Part D

Medicare Part D covers prescription drugs deemed medically necessary in treating alcohol use disorders at a Medicare alcohol rehab. This includes medicines used during detoxification and maintenance, such as:11

  • Acamprosate
  • Naltrexone
  • Disulfiram
  • Antidepressants
  • Antipsychotics
  • Anticonvulsants

Alcohol Rehab Medigap

You can purchase supplemental plans for extra coverage. Medicare Supplemental Insurance, or Medigap, covers copays, deductibles, and other expenses set by your Medicare parts A and B. It also covers medical costs during travel.11

What Is Not Covered in Alcohol Rehab Medicare?

Each alcohol rehab Medicare insurance program and its supplemental parts list services not covered. Before agreeing to services within a Medicare alcohol rehab program, it is essential to know these. Otherwise, you could be responsible for paying out-of-pocket. Services not covered include:12

  • Part A does not cover private nursing care or a private room. It may not cover some amenities like television
  • Part B does not cover inpatient services of any kind. It also will not pay for durable medical equipment not deemed medically necessary
  • Part D does not cover all medications used to treat substance use disorders.

Medicare Alcohol Rehab and Telehealth Services

With the many changes in how providers offer substance misuse treatment, Medicare has adapted its policies to benefit those who have challenges in visiting a clinic or hospital. A limited number of telehealth services include the following:13

  • Individual therapy
  • Medication management
  • Screening and assessment
  • Diagnostic evaluation
  • Family therapy

To receive telehealth services, you must be able to prove why you need telehealth services, and it must also be recommended by a doctor or licensed professional.13

Home health services are available for those who cannot leave their home either or a psychological or physical condition. If leaving home creates a danger for you or someone else, you can receive home health services on an intermittent or part-time basis. Psychological nursing is an example of a home health service.13

Comparison of Original Medicare (A&B) and Medicare Advantage (C&D)

Below is a brief snapshot of the highlights and lows of the original alcohol rehab Medicare program and the alcohol rehab Medicare Advantage program. Medicare consists of parts A and B, and Medicare Advantage consists of parts C and D.14

  • Providers: With Medicare alcohol rehab, you can see any doctor in the United States that takes Medicare. With Medicare Advantage, you must see doctors within the network plan.
  • Referrals: No referral is necessary with Medicare. Some Medicare Advantage plans require a referral.
  • Cost: You pay 20% of Part B Services in Medicare alcohol rehab and a monthly premium. With Medicare Advantage, your out-of-pocket expenses will vary, and you must pay the Part B premium and their plan’s premium.
  • Coverage: Medicare covers most medically necessary services and supplies. Medicare Advantage covers the same services and supplies plus extra benefits that Medicare alcohol rehab does not cover, such as vision, hearing, and dental.

Finding a provider that takes alcohol rehab Medicare, alcohol rehab Medicaid, and supplemental insurance plans can feel overwhelming. We get it. You want to start the process of recovery. Contact our support team rather than spending a great deal of time calling alcohol rehab Medicaid or Medicare alcohol rehab programs. We can direct your call to a treatment center that takes your insurance. The treatment center can answer your question, “Does Medicare cover alcohol rehab?”

Call us anytime to speak with a treatment specialist. We are here 24/7, 800-948-8417 Question iconCalls are forwarded to these paid advertisers eager to direct you to the right treatment program.


  1. U.S. Department of Health and Human Services. (2015). What is the Difference Between Medicare and Medicaid?
  2. Medicaid and Chip Payment and Access Commission. (2022). Overview of the Affordable Care Act and Medicaid.
  3. Centers for Medicare and Medicaid Services. (2022). January 2022 Medicaid and CHIP Enrollment Highlights.
  4. Centers for Medicare and Medicaid Services. (2022). December 2021 and January 2022 Medicaid and CHIP Enrollment Trends Snapshot.
  5. Medicaid and CHIP Payment and Access Commission. (2017). Federal Requirements and State Options: Eligibility.
  6. Centers for Medicare and Medicaid Services. (2022). Medicaid Expansion and What it Means for You.
  7. U.S. Department of Health and Human Services. (2021). Annual Update of the HHS Poverty Guidelines. Federal Register 86, no. 19.
  8. The Medicaid and Chip Payment and Access Commission. (2022). Behavioral Health Services Covered Under State Plan Authority.
  9. Centers for Medicare and Medicaid Services. (2022). Mental Health and Substance Abuse Coverage.
  10. U.S. Department of Health and Human Services. (2022). Who Is Eligible for Medicare?
  11. Centers for Medicare and Medicaid Services. (2022). Medicare and You 2022: The Official US Government Medicare Handbook.
  12. Centers for Medicare and Medicaid Services. (2022). Inpatient Rehabilitation Care.
  13. Center for Medicare Advocacy. (2022). Medicare Coverage of Mental Health and Substance Abuse Services.
  14. Centers for Medicare and Medicaid Services. (2022). Compare Original Medicare and Medicare Advantage.
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