What Are Medicaid and Medicare?

State and federally-funded insurance programs like Medicaid and Medicare each have their unique benefits for Americans. Most people by now are familiar with the 2010 Affordable Care Act (ACA), a law that helped low-income families finally have access to healthcare. Not only did it give general low-income families the right to affordable healthcare, but it made it a requirement for these insurances to pay for drug and alcohol treatment services.

medical system

The result has been overwhelmingly positive, allowing people to get help for substance abuse disorders when they genuinely need help. In the past, some of the current patients would have continued in addiction, lost all, or died. Now they have the chance to get better.

Medicaid Eligibility

Five primary categories of people qualify for Medicaid. These categories are:

  • Low-income people (as specified in requirements)
  • Pregnant women
  • Parents
  • People under 19
  • People over 65

To be eligible for Medicaid, a recipient has to earn 133 percent of the federal poverty level (FPL). In 2015, this income level was $15,654.10 for a family of one, to give you an idea of a typical single person income that would qualify for this health insurance.

Medicaid Services

Medicaid covers a broad spectrum of health-related services for its recipients. You’ll find yourself never paying out of pocket for things like:

  • Preventative screenings
  • Family counseling
  • Inpatient care
  • Detox
  • Outpatient services

Likewise, medications are generally covered by Medicaid. Not all medications are covered, though, and sometimes Medicaid requires you to use a specific brand of medication, usually the generic version of a brand name. They may also restrict the number of prescriptions they will pay for in a certain period of time, such as 30 days. Overall, Medicaid is an insurance that pays for just about any medically necessary procedure or preventative screening.

Medicare Coverage

Medicare is only available to people over 65 or people with disabilities, so the income component is not part of the Medicare program. That said, it is also very inclusive insurance that will pay for drug and alcohol rehabilitation. There are four parts to Medicare: A, B, C, and D. Part A covers up to 60 days in an inpatient rehab facility and doesn’t even charge a co-pay. However, part A requires that you pay a deductible to be eligible for that 60 days. Part B covers outpatient care up to 80%. If you have a co-occurring disorder, such as bipolar disorder, Medicare Part B will also cover that.

Parts C is a private insurance plan and will include higher premiums and higher co-pays. It also covers a wider variety of services, though, and may be more economical for people who have a long list of things that they need to pay for. Finally, Part D is the prescription insurance. People who need prescriptions for their recovery plan will find that Medicare Part D takes care of this facet of the recovery.

Applying for Medicaid and Medicare

If you’re over 65 or disabled, you may qualify for one or both of these plans. There is such a thing as dual coverage, so there are people who have both Medicaid and Medicare. If you’re in a low-income situation and have no insurance, it’s very likely that you already qualify for your state’s Medicaid plan and can get free treatment for your drug and alcohol addiction through this healthcare coverage.

Many people don’t understand the complex healthcare systems in this country, and that’s okay. It is, after all, very complex. The thing you need to know is that many people who wouldn’t have qualified for insurance in the past now qualify for coverage. It is your right. If you need treatment and can’t afford it out of pocket, one or both of these insurances can help you get started.

Reaching Out for Help

Many people at first feel embarrassed about a drug or alcohol problem. They might even feel more embarrassed about seeking treatment than they feel about the addiction itself. The good news is that there’s nothing to be ashamed of, and in reality, seeking treatment is, in fact, something you should feel very proud of. Thousands of people choose to get help every year, and Medicaid and Medicare both play a large part in allowing people to get the help they need. Thanks to new rules, addiction is considered a health condition, and you can use both of these state and federally funded insurances to reach out for help.

If you have either of these insurances, you’ll need to call each prospective treatment center or outpatient program to see if they accept Medicare or Medicaid. Not every doctor and inpatient facility accepts these state and federally funded insurances, even though a good many do. The only way you can find out for sure is by calling the individual treatment facilities and asking directly if they accept your insurance. If they do, all that’s left to do is decide to go into an inpatient or outpatient facility.

If you’re in early addiction, you may prefer to get help through an outpatient program so that you can maintain more of your freedom. If you know you have a severe addiction that may need medical attention when you cease using, an inpatient facility may be right for you. No matter what decision you make, please strongly consider entering a treatment program. State and federally funded programs are accepted now more than ever before, and it could be your best chance to get help. While it can be scary to think of going into treatment at first, in time, you will realize it was one of the best decisions you ever made. And thanks to insurances like Medicaid and Medicare, more people than ever before are empowered to get help.

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