Coverage Profile

Does Medicare Cover Rehab?

Yes — under MHPAEA. Medicare must cover medically necessary substance use treatment at parity with medical care.

At a glance: Typical deductible Part A: $1,632 per benefit period (2024). Part B: $240 annual deductible., coinsurance Part A inpatient: $0 for days 1–60, then increasing daily coinsurance. Part B: 20% coinsurance after deductible.. Pre-authorization common for inpatient/residential. Verify via member services.

Medicare Coverage at a Glance

Parent company

Centers for Medicare & Medicaid Services (CMS)

Members covered

65+ million

Deductible range

Part A: $1,632 per benefit period (2024). Part B: $240 annual deductible.

Typical copay

Part A inpatient: $0 for days 1–60, then increasing daily coinsurance. Part B: 20% coinsurance after deductible.

OOP max

No OOP max in Original Medicare (Parts A/B). Medicare Advantage plans have a statutory OOP max ($8,850 in 2024).

Member services

1-800-MEDICARE (1-800-633-4227)

Medicare provides addiction-treatment coverage under a complex framework: Part A covers hospital-based detox and residential SUD treatment at "acute hospital" facilities; Part B covers outpatient therapy, MAT, and partial-hospitalization programs; Part D covers pharmacy dispensing of buprenorphine-naloxone and certain other medications. Under the Consolidated Appropriations Act of 2021 and the 2023 IOP final rule, Medicare now covers Intensive Outpatient Programs (IOP) as a distinct benefit, narrowing a historical coverage gap.

Medicare Plan Types — What Each Covers

Not all Medicare plans cover rehab the same way. Coverage depends on plan type from your ID card.

Original Medicare (Parts A + B)

Direct federal coverage; no network; widely accepted. Typically paired with a Medigap supplement or Part D pharmacy plan.

Medicare Advantage (Part C)

Private plans that administer Medicare benefits. Network typically narrower; behavioral-health utilization review varies by plan.

Medicare Part D

Prescription-drug coverage; covers MAT medications dispensed at retail pharmacies.

Medigap Supplement

Pays Original Medicare cost-sharing; different letter plans (G, N, etc.) offer different coverage combinations.

Dual-Eligible (Medicare + Medicaid)

Low-income older adults and people with disabilities; typically lowest out-of-pocket cost.

Common Medicare Denial Reasons

Knowing these before admission lets your facility submit stronger first-time authorization.

! Original Medicare: denial for stays beyond the 60-day full-coverage window; coinsurance kicks in but treatment continues.
! Medicare Advantage: denial for out-of-network treatment without prior authorization.
! Denial of specific medications outside Part D formulary — resolvable with prior-authorization exceptions.
! Billing confusion between Part A and Part B for PHP/IOP services — administrative issue, typically resolved through Medicare claims processing.

If Medicare denies your claim — appeal timeline

Medicare claim appeals follow a five-level structure. Level 1: Reconsideration by the Medicare Administrative Contractor within 120 days of the claim decision. Level 2: Reconsideration by a Qualified Independent Contractor. Level 3: Administrative Law Judge hearing. Level 4: Medicare Appeals Council. Level 5: Federal court. For Medicare Advantage, plans have separate internal-appeal procedures with the same federal oversight.

Frequently Asked Questions About Medicare

Does Medicare cover 90-day residential treatment?

Original Medicare Part A covers hospital inpatient stays up to 90 days per benefit period, with coinsurance for days 61–90. Non-hospital residential typically is not covered under Original Medicare but may be covered under Medicare Advantage plans with supplemental benefits.

Does Medicare cover Suboxone?

Yes. Generic buprenorphine-naloxone is on most Part D formularies. Brand Suboxone may require prior authorization or higher tier copay.

What is the difference between Original Medicare and Medicare Advantage for SUD?

Original Medicare uses the national fee-for-service structure without networks; Medicare Advantage plans are private-administered, typically with narrower networks and potentially stronger care coordination. Medicare Advantage has a statutory OOP max; Original Medicare does not.

Does Medicare cover outpatient therapy for SUD?

Yes, under Part B, at 20% coinsurance after the Part B deductible is met. Therapy must be with a Medicare-enrolled provider.

Coverage details vary per specific plan. Verify with Medicare member services before admission. Last updated April 2026. Sources: MHPAEA (CMS), KFF Health Tracking, SAMHSA, Medicare member resources. See our editorial policy.