Medicare is federal public health coverage for people ages 65 and older, in addition to some people under age 65 who have disabilities or specific health conditions. About 60 to 65 million people currently access health insurance through Medicare. Original Medicare has several parts: Part A, Part B, and Part D.

Another option is to get a Medicare Advantage plan, known as Medicare Part C, which offers the same coverage as Original Medicare with some additional benefits and limitations. Medicare Advantage plans are offered by private insurance companies rather than the federal government.

Does Medicare Cover Addiction Treatment?

Original Medicare and Medicare Advantage plans generally cover medically necessary mental health and substance abuse treatment. The amount of out-of-pocket costs you pay, such as your copayment, coinsurance, and deductible, may vary depending on your specific plan options.

Different types of treatment are covered by different parts of Original Medicare. For example, Medicare Part A covers hospitalization and, therefore, would be the coverage that applies to inpatient or residential treatment. Medicare Part B covers doctor’s visits and outpatient addiction care. Medicare Part D covers many of the prescription drugs used for mental health and substance use treatment, although coverage may depend on where the medication is administered.

Medicare Advantage plans operate similarly to private insurance. You’ll get at least as much coverage as Original Medicare and often additional benefits as well. You’ll usually have specific copayments instead of paying a percentage of the cost in coinsurance. However, you may need to stay within the plan’s provider network to get coverage, and you may need referrals to visit specialists such as mental health professionals and addiction treatment centers.