According to the 2010 Affordable Care Act (ACA), Medicaid is defined as “a public insurance program for low-income families.” Also known as “Obamacare,” insurance companies (including Medicaid) are required to cover drug and alcohol rehabilitation and recovery from addiction. Unfortunately, that requirement to cover all rehab related medical expenses doesn’t compel all rehab facilities to accept Medicare and Medicaid as payment options. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the very best source to find additional information on coverage and to locate a local facility that accepts public medical assistance.

Eligibility Requirements For Medicaid and Medicare

Though some states provide medical assistance to all adults earning less than a set minimum income threshold, eligibility requirements vary by state. Typically, those receiving SSI (Supplemental Security Income) for disability also eligible for Medicaid. The ACA mandates all states to provide medical assistance in the form of Medicaid to any resident earning less than 133 percent of the federal poverty level. However, those making more may still be eligible if their income again falls within specific income requirements. Where a citizen may not be eligible for no-cost insurance, many find that they would still benefit by applying due to new sliding-scale payment schedules.

Medicare, on the other hand, is available to senior citizens (citizens over the age of 65) and those under the age of 65 with disabilities. Available for a monthly premium, state medical assistance can sometimes pay the entire monthly Medicare premium if the individual is also available for medical assistance based on income guidelines. Medicare, like all other insurance companies, is required to provide basic drug and alcohol rehabilitation, physical therapy after surgery, and where needed, a stay in a nursing home or a personal caregiver for those unwilling to stay at a nursing home. At the same time, they take advantage of physical, occupational, and speech therapies.

What exactly is Rehab?

Rehab Questions: Paying for Rehab with Medicaid and Medicare

Rehab, or rehabilitation, can be defined as any treatment program designed to help patients recover from illness or injury. Physical therapy, for example, helps patients relearn how to perform activities of daily living, such as relearning how to walk after a stroke. Speech therapy focuses on helping patients who have suffered a brain injury or stroke learn how to speak again and how to understand what is being said. Occupational therapy focuses on assisting patients in relearning how to brush their hair, vacuum their carpets, and all the other myriad activities that most humans take for granted in day-to-day life. Drug and alcohol rehabilitation encompasses helping patients to be more comfortable and withdraw from their addictive substance in a safe environment but also focuses on teaching coping mechanisms and defense strategies to help patients learn how to live their lives happily without drugs or alcohol.

When Medicare Covers Rehab

There are two types of Medicare coverage. Medicare Part A and Medicare Part B each covers different kinds of services. For necessary medical services, both parts come together to pay 80% of the bill. Unfortunately, trying to glean some insight into what any insurance covers and when it does not cover specific procedures and services can be nearly impossible for the average person. The rules and policies change regularly and can be convoluted to understand. Anyone with questions about coverage can call the phone number on the back of the insurance card, or go to the local Social Security office and ask a representative directly.

As a general rule, Medicare Part A does cover rehab services and related medical expenses in a hospital’s rehabilitation unit. In some cases, it will also provide coverage for rehab in a hospital’s SNU (Skilled Nursing Unit) or at a skilled nursing home. A crucial qualifier is having spent at least three days in a hospital. After a three-day stay as an inpatient at a hospital, part A will cover up to 100 days in a benefit period at an inpatient rehab facility. The “benefit period” begins when you are initially admitted to the hospital and ends after sixty days of not receiving any medical or skilled care. Insurance pays 100% of the cost for the first twenty days, and 80% after that until 100 days of rehabilitative care have been consumed in a single benefit year. After 100 days, part A or B will not cover any rehab costs until the next benefit year.

It’s important to note that your doctor must certify that you have a medical condition necessitating continued medical supervision, coordinated care, and intensive rehabilitation. In some cases, a physician or other health practitioner may recommend more rehab services than insurance will cover or services that insurance doesn’t cover. Asking questions is the best way to understand how such services will benefit and what will be covered by insurance.

Some Employers Pay Employees to go to Rehab

The Substance Abuse and Mental Health Services Administration (SAMSA) ranks businesses and industries according to drug and alcohol usage. SAMSA has identified individual factors in each sector contributing to drug and alcohol abuse. One of the most significant factors contributing to addiction in the workplace is a low page. Coupled with long hours slaving away to barely make ends meet, it only understands how a glass of brandy or a bottle of beer can start to look like an overworked laborer’s best friend.

In the healthcare field, employees have relatively easy access to prescription drugs. The amount of stress the typical healthcare worker experiences drives some to start abusing prescription drugs or alcohol to cope. Whatever the specific reasons, employers in virtually every industry are well-versed on the safety issues and material costs of having addictions. In many cases, it is much more cost effective to send an employee to drug and alcohol treatment centers than to fire them and retrain new employees who may well wind up addicted as well.

Substance abuse in employees has several detrimental social effects. Namely, employees who abuse substances have higher rates of absenteeism, perform poorly on the job, and sometimes develop an uncharacteristic temper that can make tension in the workplace worse for everyone. The problem is growing by leaps and bounds and has inspired many companies to find solutions. In some cases, larger companies hire healthcare workers and establish a private rehab in or near the workplace. Still, even those with few resources can help employees by posting contact numbers to confidential substance abuse hotlines and rehab facilities.

Though the idea of seeking out help for addiction can be both scary and embarrassing, it doesn’t have to be. Family, friends, and even healthcare workers are all there to support individuals suffering from addiction. Thankfully, the ACA mandates public and private sector insurance companies to cover drug and alcohol rehabilitation. Whether recovering from addiction or rehabilitating after a severe illness or injury, the cost doesn’t have to be the biggest concern. Medicare covers the full expense of the first 20 days in any included rehabilitation unit, and 80% for another 80 days if needed. The Substance Abuse and Mental Health Services Administration can give individuals seeking information about which rehab facilities accept their insurance in their area a nudge in the right direction.