What To Do When Your Rehab Medicare Coverage Runs Out

What to Do When Your Rehab Medicare Coverage Runs Out

The duration of substance abuse rehab is not fixed. Depending on the patient, it can be as quick as 30 days. In some cases, it may last for 60 to 90 days.

In extreme cases, the treatment may need to last longer. Unfortunately, this can be an issue if you depend on Medicare to fund your treatment. That’s because after 100 days in the facility, your Medicare insurance will no longer cover your expenses. The coverage may even be shorter, should Medicare see that you no longer need skilled nursing care.

If you only depend on Medicare – but need more time for rehab – then here are some things you can do once your coverage runs out.

1. See if You Eligible for Medicaid

Medicaid is a federal and state program that provides health coverage to certain populations. These include low-income families, children, pregnant women, and people receiving supplemental security income.

You may be eligible for Medicaid and its rehab benefits if you fit the Modified Adjusted Gross Income. This considers your income and tax filing relationships.

Even if you have a higher income, you may qualify as a ‘medically needy’ individual. This means that even if you don’t meet the poverty levels, you are eligible because you need to spend a lot of money on treatment that is not covered by insurance.

Should you be qualified for Medicaid, it will cover your need for long-term residential treatment. Apart from that, it will also shoulder the expenses for the following services:

  • Screening
  • Intervention
  • Medications (for maintenance and cravings)
  • Family counseling
  • Hospital/inpatient care
  • Detox
  • Outpatient care
  • Other necessary mental health services

2. Enroll in the Affordable Health Care Medical Insurance

Under the Affordable Care Act (ACA), you may have better access to medical, dental, and other types of insurance. Through this, you can avail of any plan available in the state or federal marketplace. At the same time, the insurer may not deny you coverage due to an existing condition such as addiction.

While enrollment is only open during November, you may enroll any time of the year if you are:

  • Getting married or divorced
  • Having a baby or new dependent
  • Losing health coverage/insurance
  • Moving to a new state

Depending on the insurance you choose, you may enjoy the following benefits:

  • Bronze – 60% coverage
  • Silver – 70% coverage
  • Gold – 80% coverage
  • Platinum – 90% coverage

Under the ACA, you may be entitled to inpatient services such as medical detox. It also covers various parts of addiction treatment, such as:

  • Drug and alcohol testing
  • Evaluations
  • Interventions
  • Medications for addiction or cravings
  • Clinic visits
  • Home health visits
  • Family counseling

3. Ask Help from Family or Friends

Having a strong support group can help you get through the horrors of addiction. On the other hand, you may also try to ask for financial help from your family or friends. The money you receive may be a gift – or something that you need to pay for in the future. More often than not, they’re sure to give a good amount – especially if they see that you’re dedicated to your treatment.

4. Apply for Scholarship

Just like school, you may apply for a scholarship to cover the rest of your rehab treatment. Here are some institutions that provide rehab scholarship:

10,000 Beds Scholarship Program

This non-profit organization provides 250 scholarships annually to eligible individuals. You can fill up an online application form through their website every Monday. It only consists of 14 easy questions.

To qualify, you need to:

  • Want to get better
  • Have addiction treatment
  • Be ready to commit to a minimum of 30 days in a facility
  • Have insufficient funding to cover treatment
  • Have exhausted all sources of funds (family, friends)

Sobriety Optimization League

Formerly the SOL Scholarship Foundation, the league provides scholarships to Utah adults in need of treatment. You can easily apply for a scholarship through its website.

5. Raise Funds

Many people who need funding for healthcare usually do so through fund-raising portals. These include GoFundMe, CrowdRise, YouCaring, and IndieGoGo. As long as you are comfortable telling your story and sharing it to various social media portals, you may get the funding that you need through this method.

6. Take a Loan

If you are not qualified for Medicaid or ACA insurance, then you may need to take out a loan to pay for rehab. Here are some entities that offer financial loans for substance addiction treatment:

  • My Treatment Lender, which offers loans ranging from $500 to $100,000.
  • LightStream, which offers financing options ranging from $10,000 to $24,999.
  • Prosper, which provides low-interest financing options that you can pay every month.
  • Freedom Consultancy, which offers financing through several service providers.

7. Apply for a Healthcare Credit Card

If you have a credit card, you may use it to pay for your rehab. But if you want to have lower interests and more flexible payment plans, then you should consider applying for credit cards that specialize in healthcare financing. Examples include CareCredit, AccessOne Credit, and United Medical Credit.

8. Enroll in a Free Rehab Center

If you are unable to generate the funds that you need to continue treatment in rehab, then you may consider enrolling in free rehab centers in your area. A good example is a faith-based rehab, such as that of the Salvation Army Adult Rehab Center. Here, patients are given spiritual, social, and emotional assistance to help them recover from their addictions.

Another option is a government-subsidized rehab center, which is available to patients who cannot afford drug or alcohol treatment.

9. Go for ‘Cheaper’ Rehab

If your facility’s fees are too much for you, you may try to go for centers that offer affordable payment options. One option is a facility that offers sliding-scale fees. That means your fee will depend on your ability to pay for the treatment.

You may also want to enroll in non-profit rehab centers. These facilities often provide payment assistance, so that you get the treatment that you need without worrying about the need to pay steep fees.

Even if your Medicare coverage runs out, you can still receive the rehab that you need. By following the tips above, you may continue your path towards sobriety – without worrying about expensive out-of-pocket fees.


Latest posts by Raychel Ria Agramon, BSN, RN, MPM (see all)

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