Does Medicare Cover Inpatient Rehab?

TL;DR:

• Medicare covers inpatient rehab for drug and alcohol addiction if certain conditions are met.
• Requirements include medical necessity, a need for skilled nursing care, and choosing a qualified facility.
• Coverage includes various services like room, meals, therapies, and medications.
• Medicare covers inpatient rehab for a lifetime maximum of 190 days.
• Resources like the Medicare website and your doctor can help you find a suitable rehab facility.

Millions of Americans struggle with substance abuse every year. With overdose deaths on the rise, the demand for effective addiction treatment is higher than ever. But if you’re on a fixed income and depend on Medicare for healthcare, you might be wondering: does Medicare cover inpatient rehab?

Medicare is a federal health insurance program primarily for people 65 and older, but it also covers some younger individuals with disabilities. It’s a vital resource for many needing medical care, but figuring out how it works can be challenging—especially when it comes to addiction treatment.

The good news is Medicare does cover rehab. But there are some conditions and requirements you’ll need to meet to qualify.

Medicare Requirements for Inpatient Rehab Coverage

If you’re wondering, “Does Medicare cover inpatient alcohol rehab?” or “Does Medicare cover inpatient drug rehab?”—the answer is yes. However, there are some specific requirements and conditions you’ll need to meet for coverage.

Medicare Eligibility

First off, you need to be enrolled in Medicare Part A, which covers hospital insurance. Most people automatically get Part A when they turn 65 if they or their spouse paid Medicare taxes long enough. Younger individuals with disabilities might also qualify for Medicare.

Medical Necessity

Medicare will only cover inpatient rehab if your doctor says it’s medically necessary. This means:

• You need intensive rehab services that can only be done in a hospital.
• You require a coordinated care program with multiple therapies.
• You’re expected to make significant improvements through rehab.

Overall, your doctor needs to decide that inpatient rehab is essential for your recovery and that you wouldn’t make the same progress in a less intensive setting.

Skilled Nursing Care

Medicare requires you to need daily skilled nursing care during your inpatient rehab stay. This means a registered nurse or licensed practical nurse has to provide care that:

• Is needed to treat your condition.
• Requires a professional’s expertise.
• Can’t be safely or effectively done by untrained individuals.

Inpatient Rehab Facility Requirements

The facility where you get inpatient rehab has to meet certain Medicare requirements for coverage. These include:

• Offering intensive rehab therapies.
• Having a doctor actively involved in your care plan.
• Meeting quality and safety standards.

By meeting these requirements, you’ll have a better chance of getting Medicare to cover your inpatient rehabilitation.

What Does Medicare Cover in Inpatient Rehab?

So, you’ve met the requirements and Medicare covers your inpatient rehab. But what exactly does that coverage include? Here’s a breakdown of the typical services Medicare covers during your stay:

• Semi-private room
• Meals
• Nursing services
• Rehab therapies
• Medications
• Detox

With Medicare Part B and D, you can also get coverage for:

• Outpatient services
• Partial hospitalization services
• Behavioral health integration services
• Prescription drugs

It’s important to note that Medicare Part A has cost-sharing requirements. This means you may be responsible for:

• Deductible: You’ll need to pay a deductible for each benefit period.
• Coinsurance: You may have coinsurance costs for days 61-90 of your inpatient stay.

If you’re wondering, “Does Medicare pay for inpatient rehab in its entirety?” the answer is that it covers a significant portion, but you may have some out-of-pocket expenses.

For a clear idea of what you’ll need to pay, it’s a good idea to contact Medicare directly or talk to a Medicare specialist for a personalized estimate.

How Long Does Medicare Cover Inpatient Rehab?

Understanding Medicare’s benefit periods and coverage limits is key to planning your recovery.

Benefit Periods

A benefit period begins the day you’re admitted to a hospital or skilled nursing facility and ends when you’ve been out of the hospital or facility for 60 consecutive days.

Duration of Coverage

Medicare has a lifetime limit of 190 days for inpatient rehab. It’s important to know that this is not per benefit period. Once you’ve used up those 190 days, Medicare won’t cover any more inpatient rehab stays.

It’s important to make the most of this limited coverage and work with your healthcare team to get the most out of your inpatient stay. If you think you’ll need more rehab beyond the 190-day limit, it’s a good idea to look into other options such as private insurance or alternative treatment programs.

Finding a Medicare-Approved Inpatient Rehab Facility

Once you’ve decided that inpatient rehab is the right choice and you’re clear on Medicare’s coverage, the next step is finding the right facility.

Use the Medicare Website

Medicare offers a powerful tool called “Care Compare.” It lets you search for Medicare-certified facilities, including inpatient rehab centers. You can filter by location, type of facility, and specific services like substance abuse treatment.

The Care Compare tool also gives you useful info about each facility, like quality ratings, patient satisfaction scores, and inspection results. This can help you choose the best place for your care.

Talk to Your Doctor and Treatment Team

Your primary care doctor or healthcare provider can be a great resource for finding the right rehab facility. They often know about local options and their reputations.

If you’re already seeing a therapist or counselor for addiction, they can also give recommendations and help guide you through the selection process.

Your Next Steps in Recovery

Figuring out Medicare coverage for inpatient drug and alcohol rehab can feel overwhelming, but understanding your benefits is the first step toward recovery.

If you or someone you care about is struggling with addiction, don’t let uncertainty about insurance stop you from getting help. Recovery is possible, and there are resources to support you.

At Infinite Recovery, we get how complex addiction can be and know how important personalized care is. We offer complete drug and alcohol rehab programs in a supportive, healing environment. Our team of experienced professionals is here to help you achieve lasting sobriety.

Reach out to Infinite Recovery today to learn more about our services and how we can help you on your recovery journey.

We’re here to support you every step of the way.