What Is Medicare?

According to Statista, Medicare is a, “federal social insurance program introduced in 1965.” It is offered to eligible individuals, and it can be used in different ways. Medicare can be a person’s sole insurance or be used as a supplement if the person has other insurance. The availability of Medicare has resulted in a steady increase of 13% of Americans receiving coverage in 1990 to 18% of Americans receiving coverage in 2019. It has been reserved for individuals 65 and over and disabled persons.

Individuals who qualify for Medicare are able to access 2 types of Medicare support, which according to Medicare.gov are Medicare and Medicare Advantage. Furthermore, Medicare can be combined with other insurance for those who qualify. Medicare does not cover full healthcare costs but offers partial coverage available in varying parts. Examples of coverage range from medical visits, to alcohol withdrawal care and prescription medications, to mental health services.

Enrollment occurs automatically once an individual reaches 65 and they can access both Part A (which covers hospital visits) and Part B (which covers medical visits) and requires a payment of a monthly premium for all the months the individuals will be needing Part B coverage.

Who Is Eligible?

Medicare eligibility occurs in Parts A (hospital insurance) and B (medical insurance). When you combine Medicare Part A with Part B, it forms the original Medicare offered. When someone enrolls for Medicare, they will automatically receive Part A, and individuals have the option to include Part B, C, and D to their plan if they qualify. Part C is called Medicare Advantage, and Part D is the Medicare prescription drug benefit. Medicare was traditionally reserved for people 65 and older and disabled persons. As of late, Medicare coverage has included older and disabled people, but has recently included individuals suffering with End-Stage Renal Disease. Those eligible must also be age 65 or older, a US resident, and be either a US citizen or legal immigrant.

Individuals over 65 years old can get Medicare without paying premiums. Furthermore, they can qualify for premium-free Medicare if they meet certain criteria:

  • You have received retirement benefits from the Railroad Retirement Board.

  • You or your spouse have received Medicare-covered governmental insurance.

  • You have received retirement benefits from Social Security.

Part D covers prescription drugs; Part D has individual premiums. Lastly, individuals over 65 can qualify for Medicare if they have received Social Security disability insurance and have waited 2 years. For more eligibility coverage, connect to HHS.gov or Medicare.gov.

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Medicare Costs

After an individual meets the Part B deductible for inpatient mental health coverage, they will pay 20% of the Medicare-approved amount for each service they get from a doctor or specific other qualified mental health professional. For outpatient mental health care, an individual will pay $0 for yearly depression screenings and 20% of the Medicare-approved amount for visits to the doctor or other health care provider to diagnose or treat one’s condition.

Medicare Advantage: What Is It?

Medicare Advantage (or MA plans) is another option for those who want Medicare. This alternative plan covers insurance for services and conditions that are not covered in the Original Medicare plan. The Medicare Advantage plan is offered by private insurance companies and are often bundled with Medicare plans. According to Medicare.gov, patients can expect to have Part A which covers hospital insurance, Part B, which covers medical insurance, and Part D, which offers coverage for the medication (including alcohol withdrawal or treatment medications). Other coverage includes:

  • Over the counter medication.

  • Transportation to doctor’s offices for visits.

  • Vision plans.

  • Fitness memberships.

  • Dental.

  • Hearing plans.

Fortunately, some Medicare Advantage plans have no premium, although some charge different costs out of pocket. Costs for the Medicare Advantage plans vary on factors, including but not limited to:

  • The type of treatment needed.

  • If your plan has a yearly deductible.

  • If you receive state funding or receive Medicare.

Individuals seeking more information about costs for Medicare Advantage can access Medicare.gov to see the breakdown for costs and plans.

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 What Medicare Covers

Medicare covers the costs of many health conditions; however, it also depends on what the plan has. There are different services that Part A will cover that Part B will not, or that Medicare Advantage will cover but original Medicare will not. Part A covers inpatient nursing home stays, hospital-based services, and home healthcare. If a patient with Medicare battles alcohol abuse and is hospitalized, he or she can receive coverage if the hospital accepts it. Medicare has specific criteria required before it will cover any substance abuse treatment, such as:

  • One’s provider must report that the services are medically necessary
  • All services must be received from a Medicare-approved provider or facility (most often a hospital)
  • The provider must set up the plan of care

For Part B, Medicare covers “medically necessary” and preventive services, home healthcare, inpatient and outpatient care for mental health services, medical equipment, some outpatient prescription drugs, and clinical research. Part D covers prescription medication and medication for substance abuse, including medication for alcohol withdrawal.

Medicare Coverage For Alcohol Addiction Treatment

Part B allows for individuals with Medicare to get alcohol screenings once a year free of charge. Such people must be an adult and does not have to struggle with alcohol abuse. Additionally, he or she can get counseling if there is a problem with alcohol abuse, with Medicare covering 4 brief one-on-one sessions for free. Fortunately, Medicare also covers inpatient and outpatient care for those facing substance abuse, but there are also out-of-pocket expenses and premiums to be considered. For alcoholism, for instance, individuals can access Medicare for coverage under the following guidelines:

  • The provider sets up the plan of care.

  • Your provider believes the services are medically necessary.

  • All services must be received from a Medicare-approved provider.

Additional alcohol-treatment related Medicare coverage includes:

  • Psychotherapy.

  • Hospital follow-ups.

  • Individual or group therapy.

  • Outpatient treatment medication.

  • Prescription drugs administered during a hospital visit or in a doctor’s office.

Some drugs may not be covered. To get more information, contact your local Medicare office to inquire.

Get The Treatment You Deserve

Individuals battling alcoholism who meet the requirements for Medicare have several options for coverage. Elderly alcoholism can be extremely devastating to the mind and body of those who endure it. Still there is hope. If you or a loved one faces alcoholism, contact a treatment provider to inquire how Medicare can cover you.

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