Medicaid & Medicare Coverage for Rehab
Both Medicaid and Medicare cover substance use disorder treatment. Understanding what each program covers, how they differ, and how to access benefits can save you thousands and remove barriers to getting help.
Medicaid vs. Medicare
What Medicaid Covers
Medicaid is the largest payer for behavioral health services in the United States. All state Medicaid programs cover substance use disorder treatment, though the specifics vary by state.
Detoxification
Medically supervised withdrawal management in inpatient or outpatient settings. Covered in all states as a medically necessary service.
Inpatient / Residential Treatment
24/7 supervised residential programs. Many states have obtained IMD exclusion waivers to expand coverage for facilities with 16+ beds.
Outpatient Treatment
Individual counseling, group therapy, intensive outpatient programs (IOP), and partial hospitalization programs (PHP).
Medication-Assisted Treatment (MAT)
Buprenorphine, methadone (through OTPs), and naltrexone. All states required to cover at least some MAT under the SUPPORT Act.
Mental Health Services
Psychiatric evaluation, therapy for co-occurring disorders (depression, anxiety, PTSD, bipolar), and crisis intervention services.
Medicaid eligibility: In expansion states, individuals earning up to 138% of the Federal Poverty Level (~$20,800/year for a single person in 2025) qualify. Non-expansion states have stricter criteria. Check Healthcare.gov for your state's eligibility.
What Medicare Covers
Medicare coverage for substance use treatment is divided across three parts. Together, they provide comprehensive coverage for most addiction treatment services.
Inpatient Hospital Services
- Inpatient detox in a hospital setting
- Inpatient rehab in a hospital or skilled nursing facility
- Semi-private room, meals, and nursing care
- Medications administered during inpatient stay
Days 1–60: $1,632 deductible per benefit period. Days 61–90: $408/day coinsurance.
Outpatient Services
- Individual and group therapy/counseling
- Partial hospitalization programs (PHP)
- Intensive outpatient programs (IOP)
- Psychiatric evaluations and medication management
- Methadone through opioid treatment programs (OTPs)
- Screening, Brief Intervention, Referral to Treatment (SBIRT)
20% coinsurance after $240 annual deductible.
Prescription Medications
- Buprenorphine (Suboxone, Subutex, Zubsolv)
- Naltrexone (oral tablets)
- Naloxone (Narcan) for overdose reversal
- Acamprosate and disulfiram for alcohol use disorder
Costs vary by plan formulary tier. Many generics available at low copay.
How to Access Benefits
Check Your Eligibility
Medicaid: visit Healthcare.gov or your state Medicaid office. Medicare: you're eligible at 65+, or under 65 with certain disabilities or ESRD.
Find a Participating Provider
Use SAMHSA's treatment locator at findtreatment.gov and filter by Medicaid or Medicare acceptance. Many facilities accept both.
Get Authorization if Needed
Some services (especially inpatient) may require prior authorization. The treatment facility's admissions team typically handles this on your behalf.
Start Treatment
If you need help now, call SAMHSA's helpline at 1-800-662-4357 - free, confidential, 24/7. They can connect you with local Medicaid/Medicare-accepting programs.
Frequently Asked Questions
Does Medicaid cover inpatient rehab?
Yes, most state Medicaid programs cover inpatient substance use treatment. Coverage varies by state - some cover up to 30 days, others cover as long as medically necessary. Medicaid expansion states generally offer broader addiction treatment coverage. Contact your state Medicaid office for specifics on inpatient coverage, duration limits, and preauthorization requirements.
Does Medicare cover outpatient addiction treatment?
Yes. Medicare Part B covers outpatient substance use treatment including individual and group therapy, partial hospitalization programs (PHP), intensive outpatient programs (IOP), medication-assisted treatment (MAT), psychiatric evaluations, and counseling. Standard Part B cost-sharing applies: 20% coinsurance after the annual deductible is met.
Can I get Medicaid if I'm currently using drugs?
Yes. Active substance use does not disqualify you from Medicaid eligibility. Medicaid eligibility is based on income, household size, and state of residence - not health status or substance use history. In fact, Medicaid is designed to help people access treatment for conditions like substance use disorder.
What medications does Medicare Part D cover for addiction?
Medicare Part D formularies typically cover buprenorphine (Suboxone, Subutex), naltrexone (oral and Vivitrol injection), and naloxone (Narcan). Methadone for opioid use disorder is covered under Part B when administered through a certified opioid treatment program (OTP). Specific formulary coverage and prior authorization requirements vary by plan.
Do I need a referral for addiction treatment under Medicaid?
It depends on your state and plan type. Managed care Medicaid plans (MCOs) may require referrals or prior authorization for certain levels of care, particularly inpatient treatment. Fee-for-service Medicaid may have different referral requirements. Contact your Medicaid plan's member services for specific referral and authorization processes.
Does Medicaid cover medication-assisted treatment (MAT)?
Yes. All state Medicaid programs are required to cover at least some forms of MAT for opioid use disorder. Most cover buprenorphine, methadone (through OTPs), and naltrexone. The 2020 federal SUPPORT Act strengthened Medicaid MAT coverage requirements. Some states have added coverage for alcohol use disorder medications like acamprosate and disulfiram.
Is there a limit on how long Medicare covers rehab?
Medicare generally covers treatment as long as it is medically necessary. Part A covers up to 60 inpatient days per benefit period at a set copay, with increased cost sharing for days 61–90 and lifetime reserve days. Part B outpatient coverage has no specific visit limit for substance use treatment, but services must be medically necessary and ordered by a physician.
Can I have both Medicaid and Medicare (dual eligible)?
Yes. People who qualify for both are called 'dual eligibles.' Being dual eligible often results in the lowest out-of-pocket costs because Medicaid typically covers Medicare premiums, deductibles, and coinsurance. About 12 million Americans are dual eligible. Contact your state Medicaid office to determine if you qualify for both programs.
Does Medicaid cover detox?
Yes. Medical detox is covered by Medicaid in all states as a medically necessary service. The IMD exclusion (which restricts Medicaid payments to institutions with more than 16 beds) has been waived in many states through Section 1115 waivers, expanding access to detox in larger facilities. Prior authorization may be required depending on your state.
How do I apply for Medicaid?
Apply through your state Medicaid agency, Healthcare.gov (during open enrollment or with a qualifying life event), or in person at your local Department of Social Services. Many states offer year-round enrollment for Medicaid. You'll need proof of income, identity, residency, and citizenship/immigration status. Many treatment facilities can help you apply during the intake process.
This page is for informational purposes only. It does not replace professional medical advice. Contact your Medicaid or Medicare program directly for current coverage details.