What to Know About Medicare and Drug Treatment for Veterans

Are you a veteran dealing with an addiction to drugs or alcohol? Enrolling in a healthcare plan is the first step in seeking mental health therapy or addiction treatment using your Veteran Assistance (VA) insurance benefits for drug misuse treatment. Ideally, you already enjoy the VA benefits, but if not, this is the perfect moment to do so. Other than the issues of drug misuse, you are entitled to comprehensive medical care for your service-related medical requirements.

Once you enroll with a VA insurance provider, the next step is to visit your Veteran Assistance medical provider to discuss all your medical concerns and the struggles you have relating to your mental health and substance abuse. At this stage, it’s important to be honest about your situation so that the doctor can provide a proper diagnosis.

The doctor may recommend diagnoses, screenings, or referrals as they may deem necessary. If you suffer from more than one mental health problem (anxiety, survivor’s guilt, grief, or depression), it will be upon your healthcare provider to develop a personalized and practical treatment program for you. This is because all these mental issues could be contributing to your substance use disorder (SUD) and must, therefore, be considered in your treatment plan.

What If You Have Another Health Insurance Plan On Top of the VA Insurance?

As a veteran, you may have VA insurance and another type of separate health insurance. In that case, you can get confused as to which plan is relevant to your case. Fortunately, you are free to use other insurance coverage in addition to your VA insurance if you feel the alternative insurance will provide you with a better addiction treatment plan than the VA insurance.

However, you’ll have to provide the VA with the details of your alternative coverage, whether it’s a private insurance plan, TRICARE, or Medicare. Doing so ensures that the VA insurance can take care of your service-related treatments while the other coverage takes care of the non-service-related treatments you may need.

Most insurance experts advise that you should enroll in a Medicare plan when you hit 65 years old, even if you’ve enrolled in VA insurance. Medicare provides a large pool of doctors that will be available at your service, and even if your budget impacts your VA insurance care, your medical coverage will still be intact.

Addiction Treatment for Veterans

As an experienced military veteran, you are different from American civilians. You have likely faced stressful situations that can put you at a higher risk of substance use disorder and other mental health issues. In fact, approximately one in 10 veterans struggles with substance use. According to research, another one in four veterans shows symptoms of a mental health condition like post-traumatic stress disorder, depression, or anxiety. Often, veterans dealing with these issues turn to drugs as a way to cope, and this leads to addiction.

If you are struggling with addiction, you can turn to the VA for treatment. However, you may realize that the VA programs near you are overcrowded with a long waiting list. This explains why you may look for an alternative way to cover your treatment. Your local VA office can help you search and review the alternatives available to you, one of which is Medicare.

Medicare Rehab Coverage

Medicare is an insurance plan that can help if you are struggling with SUD. It doesn’t matter the drug in question. If you are 65 years old or older, Medicare can help you start your recovery journey. This coverage is very reliable, though it has its own limitations and eligibility requirements. It’s best to understand how Medicare works so you can fully benefit from it.

What Is Medicare?

Medicare is a government-backed health insurance program for people who are 65 years old and older. It also covers some young disabled Americans. As a veteran, you can have both VA insurance and Medicare, but you’ll only use one for a particular case.

Though VA insurance offers more comprehensive benefits to military personnel and veterans than Medicare, it’s best to consider having both. Again, if a VA program isn’t available or is far away from your home, your best alternative would be Medicare. Millions of people are already enrolled in Medicare, and many eligible people join the program every year. Medicare has three parts as described below:

• Medicare Part A: This part will take care of your inpatient care, hospice, nursing home care, and some home-based medical care.
• Medicare Part B: This part covers office visits, preventive services and care, medical supplies, and outpatient care.
• Medicare Part D: This part will take care of all your prescription drugs, vaccines, and flu shots.

You have the freedom to combine Medicare A, B, and D if you want comprehensive medical coverage. However, you have to remember that each comes at a cost in terms of premiums.

On top of these Medicare plans, there are two more Medicare types you can choose from:

• Original Medicare: This plan includes Medicare Parts A and B. With this plan, you’ll be required to pay what’s referred to as a copay fee. The fee is 20% of the service cost. If you wish, you can add Part D (the prescription plan).
• Medicare Advantage: The Medicare Advantage option is billed as an “all-in-one cover” because it includes Medicare plans A, B, and D. This plan also includes additional services, some of which are not provided by Original Medicare.

Many facilities that offer rehab treatment to those with drug and alcohol addiction accept Medicare. So, if you feel your condition warrants rehab treatment, you can rest assured that Medicare will take care of your needs.

Are you eligible for Medicare?

Before you try signing up for Medicare, it’s good to find out whether you meet the set eligibility criteria. Generally, you’re qualified for Medicare coverage if you are 65 years of age or older. Younger people with disabilities and those who have been diagnosed with ESRD (permanent failure of the kidney that requires a transplant or dialysis) may also qualify.

What Type of Substance Use Treatment Does Medicare Cover?

While the Medicare coverage available for mental and behavioral health issues and substance use is not as extensive as its coverage for other health problems, the insurance still covers a range of drug and alcohol treatment services for qualifying veterans. This includes treatment in both an inpatient and outpatient setting.

Inpatient treatment is covered under Medicare Part A, and the copays are the same as they are for any other type of inpatient hospitalization. For outpatient treatment from a clinic or outpatient department at a hospital, Medicare Part B provides coverage. Whether they’re offered in an inpatient or outpatient facility, the services that Medicare will cover are the same. Some of the covered services include:

• Screening and diagnostic services
• Psychotherapy
• Patient education and counseling
• Post-hospitalization follow-up
• Online/telehealth treatment

It’s also important to note that Medicare will cover partial hospitalization programs, which are also referred to as intensive outpatient drug rehab. Typically, these programs are operated by hospital outpatient departments or community mental health centers. Medicare does not cover transportation or meals provided by these facilities, but it does provide coverage for all other partial hospitalization services, including diagnostic services, therapeutic activities, family counseling, social services intervention, and patient education.

What About Medication-Assisted Treatment

Many treatment facilities also offer medication-assisted treatment (MAT) alongside counseling and other therapies as part of a whole-patient approach to sustain recovery and prevent relapse and overdose. There are various medications used in this type of treatment, including acamprosate and disulfiram for alcohol use disorder and methadone and buprenorphine for opioid use disorder. Medicare covers MAT programs, including some of the medications used.

MAT inpatient and outpatient care are covered by Medicare Part A and B, respectively. Medicare Part D covers MAT medications such as buprenorphine and naltrexone as long as they are prescribed by participating Medicare practitioners and dispensed by retail pharmacies. Currently, however, methadone for MAT is not covered under a Medicare plan.

Can You Receive Treatment Coverage Under Both Medicare and Medicaid?

While they are sometimes confused with another, Medicare and Medicaid are two different programs. Medicare is an insurance program with the eligibility requirements mentioned above, and it’s available to those who have paid into the program while working. Medicaid, on the other hand, is an assistance program for low-income individuals of all ages.

Although it is relative uncommon, some Americans qualify for both Medicare and Medicaid and are referred to as having “dual eligibility.” If you are a veteran and one of the 20% of Americans to have dual eligibility, you may be able to access additional assistance for substance use disorder treatment. Medicaid can be used to help cover Medicare co-pays and may pay for some services that Medicare doesn’t.

Don’t Wait to Reach Out for Treatment

If you are a veteran who is struggling with an addiction to alcohol and/or drugs, you shouldn’t let uncertainties about coverage keep you from seeking the help you need. Those with Medicare can access a full range of treatment options to get on the path to long-term recovery. You can also receive coverage through the VA and other assistance programs. For help in learning more about your options, VeteransRehab.org is available with a range of resources. Reach out to us today.