Is There Medicare Coverage for Alcohol Counseling?

Takeaways

• Medicare Part B covers annual alcohol misuse screenings and up to four brief counseling sessions per year if screening indicates alcohol misuse. Screenings and counseling are covered under Part B with no cost if the provider accepts Medicare assignment. Part B may also cover outpatient mental health services for more severe alcohol use issues.
• Medicare Part A may cover inpatient treatment for substance abuse if hospitalization is needed.
• Medicare Part D can help pay for medications prescribed for alcohol dependence.
• Early screenings and counseling aim to prevent more serious dependency and health problems.
• Resources such as Alcoholics Anonymous and the National Institute on Alcohol Abuse and Alcoholism, among others, are available for support.

Alcohol misuse is more common than many realize and can lead to serious health issues, including liver disease, cancer, heart problems, and mental health disorders. According to one 2021 report, alcohol use disorders have been on the rise among those aged 65 and up, and one in 20 seniors in the United States has an alcohol use disorder.

Recognizing the importance of early detection and intervention, Medicare covers screening and counseling services related to alcohol misuse.

These benefits are designed to help beneficiaries get support before alcohol use becomes a larger medical issue, and to provide pathways to treatment if more serious dependence is detected.

Alcohol Misuse vs. Alcohol Dependency

It’s important to understand the difference between alcohol misuse and alcohol dependency.

Alcohol Misuse

Alcohol misuse means drinking in a way that increases the risk of health problems. It might involve drinking too much on occasion (binge drinking), drinking frequently, or having patterns of alcohol use that could lead to harm, but it doesn’t necessarily mean the person is addicted. Early counseling can often help people adjust their drinking habits before more serious problems develop.

Alcohol Dependency

Alcohol dependency, alcoholism, or alcohol use disorder (AUD) is a medical condition where a person physically or psychologically depends on alcohol. It often includes a strong craving for alcohol, loss of control over drinking, withdrawal symptoms, and needing more alcohol to achieve the same effects. Alcohol dependency typically requires more intensive treatment, including therapy, medications, and sometimes inpatient rehabilitation.

Medicare distinguishes between these two levels by offering brief counseling sessions for misuse and broader treatment services for dependency or addiction.

What Medicare Covers for Alcohol Misuse and Dependency

Medicare is a federal health insurance program primarily for individuals aged 65 or older, as well as certain younger people with disabilities or people with end-stage renal disease. Through the Medicare program, beneficiaries have access to screenings and counseling to help mitigate the harmful effects of alcohol overuse.

• Screening. Medicare covers one alcohol misuse screening per year for adults who use Medicare-covered services from a provider who accepts Medicare assignment. A screening involves the health care provider asking standardized questions to identify whether the patient’s alcohol use might be risky.
• Counseling. If a screening shows alcohol misuse, Medicare covers up to four brief, in-person counseling sessions per year. The patient must be alert and competent for the sessions to take place. These sessions aim to reduce alcohol misuse and are provided by a qualified primary care doctor or other qualified primary care practitioner in a primary care setting, such as a doctor’s office.

These services are covered under Medicare Part B, which is part of Original Medicare and focuses on outpatient medical care. Coverage under Part B generally includes doctor’s visits, preventative care (for example, annual screenings for alcohol misuse mentioned above), and other services, such as mental health care and durable medical equipment. If your provider accepts Medicare assignment, you don’t pay a deductible or coinsurance for the screening and counseling.

If your provider determines during your screening that you have more severe alcohol use issues, Medicare can also help with broader treatment options. Part B may cover some outpatient treatment services, which can include therapy and counseling for substance use disorders.

Medicare Part A, which helps pay for inpatient care, can cover inpatient treatment if hospitalization for substance abuse is needed. In addition, Medicare Part D (prescription drug coverage that is available through private insurers) can help pay for certain medications prescribed to treat alcohol dependence, depending on the plan’s formulary. Some of these services may require meeting specific conditions, and there may be out-of-pocket costs, such as deductibles, copays, or coinsurance, depending on the service and Medicare plan.

Medicare Advantage plans must also cover these preventative screenings and counseling sessions at no charge when you are visiting your in-network provider. However, treatment for alcohol use disorder may come with associated costs under Medicare Advantage, depending on your plan.

Why Early Screenings Matter

Catching alcohol misuse early can prevent serious health problems, such as liver disease, heart issues, cancer, and mental health disorders. Medicare’s coverage for annual screenings and brief counseling sessions is designed to intervene early, before occasional risky drinking becomes a more severe dependency that requires intensive treatment.

Some Resources for People Struggling With Alcohol Use

If you or someone you know is struggling with alcohol use, there are national and local resources available, including:

• Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is a federal agency within the Department of Health and Human Services that offers 24/7 support through a national helpline (1-800-662-HELP (4357)) as well as via online chat and text (at 988) for individuals and families facing mental health issues and substance use disorders. They can connect you to local treatment services.
• Alcoholics Anonymous (AA). AA is a peer-support program offering free, local meetings (in person and online) to help individuals stop drinking. (Al-Anon is a related support group that seeks to help family members and friends who are affected by their loved one’s alcohol use disorder.)
• National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NIAAA is part of the National Institutes of Health and conducts research and provides information about the effects of alcohol use.
• Medicare-Approved Providers. Medicare beneficiaries can ask their primary doctor or search the Medicare website for therapists, clinics, or rehab centers that accept Medicare.
• Veterans Affairs (VA) Programs. If you’re a veteran, the VA offers alcohol and substance use programs.
• State or Local Health Departments. Many counties have free or low-cost addiction services.

Learn More About Available Benefits

By covering annual alcohol misuse screenings and counseling sessions, Medicare helps its beneficiaries identify alcohol misuse before it becomes a more serious issue. And if alcohol use becomes more serious, Medicare has resources available to help with treatment.

To learn more about Medicare and its benefits, contact an elder law attorney near you. They can walk you through available options, help you with long-term care planning, and more.

For additional reading about Medicare and substance abuse, check out the following articles:

• Turning 65? What to Know About the 4 Parts of Medicare
• Medigap: Plugging the Holes in Medicare
• Who Is Eligible for Both Medicare and Medicaid?
• Medicare Advantage: An Alternative to Original Medicare
• An Epidemic: Substance Abuse a Growing Problem Among Seniors