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Medicaid and Medicare are government funded health programs that help eligible people cover some or all of the costs of their healthcare needs.1
While Medicaid and Medicare plans vary, they all include at least some coverage for substance abuse treatment, addiction treatment, and mental health services.
People often confuse Medicaid and Medicare, but they are not the same program. Medicaid is a federal and state public health insurance program. It is available to low-income American families and individuals. These beneficiaries are guaranteed coverage under Medicaid.1
Medicare, however, is a federal benefits program for people 65 years old and up, regardless of their income. It is also available to some people who are under 65 years old and have a disability.1
Medicaid is funded by the U.S. government and individual states in the United States.3
With the Children’s Health Insurance Program (CHIP), Medicaid offers coverage to more than 72.5 million Americans. It is the biggest source of healthcare coverage in the country.3
Medicaid is available to low-income families and people with qualifying disabilities. This includes:
Some states also offer other options and cover additional groups of people. For example, they include coverage for those who need home- or community-based services. Some also cover children in foster care.3
The Affordable Care Act (ACA) allows states the opportunities to expand Medicaid so that it covers almost all low-income Americans under 65.3
Income eligibility for Medicaid is based on your Modified Adjusted Gross Income (MAGI). MAGI takes into account your taxable income and tax filing relationships. To be eligible for Medicaid, you have to earn less than 133 percent of the federal poverty level (FPL).3
However, some people are exempt from the MAGI income requirements. This includes anyone whose Medicaid eligibility is based on disability, blindness, or age for those 65 and older.
Medicaid eligibility for anyone who has a disability, blindness, or is 65 or older is based on the SSI program’s methodologies.
To be eligible for Medicaid, you also have to meet other non-financial requirements. You must be a:3
Medicare is available for qualifying individuals for a monthly premium. The premium price depends on your income.4
There are four types of Medicare:4
To qualify for a Medicare plan, you must meet the following criteria:4
Some people under 65 may also qualify for Medicare health benefits if they have disabilities or other medical conditions.
You can apply for Medicare 3 months before or after your birth month when you turn 65.
Yes, Medicaid covers rehabilitation services and substance abuse treatment. Medicaid may offer free or low-cost substance abuse coverage.5
Under the Affordable Care Act (ACA), insurance providers, including Medicaid, are obligated to provide coverage for drug and alcohol addiction.
In 2009, insurance payers spent $24 billion on substance use disorder (SUD) treatment. Medicaid made up 21 percent of that $24 billion.5
However, not all drug or alcohol addiction treatment facilities accept Medicaid. It is important to ask if your chosen addiction treatment center accepts Medicaid and has space available.
Because Medicaid reimbursement rates for medical care are usually significantly less than other commercial or Medicare reimbursement rates, many facilities limit admissions.
Medicaid coverage helps with all or at least some of the cost of addiction treatment services. These include:1
Medicare covers alcohol and drug abuse and addiction services, including rehabilitation.
However, the four different parts of Medicare coverage offer different options for substance abuse treatment.
Generally, Medicare coverage includes many addiction treatment services. These include: 2,6
Medicare parts A, B, C, and D cover different services. For example, Medicare Part A covers: 6
Medicare Part B covers:
Meanwhile, Medicare Part C offers additional benefits. Still, you may have to pay out of pocket to cover some of your healthcare costs.
If you or someone you know is struggling with alcohol or drug abuse or addiction, reach out for help. Many inpatient and outpatient rehabilitation centers take Medicaid and Medicare.
To find a rehab center that takes your Medicaid or Medicare coverage, follow these steps:
Call various rehab centers to learn whether or not they accept your Medicare or Medicaid plan. Check if they have space available to care for you or your loved one.
Not all doctors practicing at a treatment center accept the same insurance plans. Ask the center if any healthcare providers accept your Medicaid or Medicare plan.
You don’t have to stick with one treatment center or program if it is not serving your recovery needs. Many places accept Medicare and Medicaid.
Just be sure to find a program that accepts your Medicaid or Medicare plan and has space available before you leave your current program.
Cutting back on or quitting substances like alcohol can be dangerous and even deadly without professional help. Also, the long-term cost of addiction is often more expensive than treating it.
Some people may be eligible for dual coverage.
Seniors who live in nursing homes may be eligible for both Medicaid and Medicare. They qualify for Medicare based on their age and Medicaid based on their financial situation.
Some Medicare beneficiaries who are younger than 65 and have access to Social Security Disability Insurance (SSDI) may also be eligible for Medicaid benefits.
If you or someone you know is coping with drug abuse or alcohol addiction, seek treatment immediately. Reach out to a healthcare provider to find options that accept Medicaid or Medicare.
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