Caring, Clinical, and Effective Drug Rehabilitation in San Diego Covered by Medicare
Our San Diego treatment program provides caring and highly effective substance abuse and dependency (SUD) treatment, designed to help those in need of recovery from alcohol or drug addiction.
Present Moments Recovery's unique brand of evidence-based treatment provides the entire continuum of care, from detoxification to sober living and outpatient treatment. All levels of care are CARF accredited and recognized for excellence.
The Present Moments Recovery continuum of care serves the growing need for evidence-based treatment of substance abuse, notably alcohol and opioids like fentanyl. Clients can start or continue their treatment in the outpatient program, receiving individual and group therapy.
Medicare may cover part or all of your substance abuse treatment costs.
Who Can Use Medicare for Addiction Treatment in California
All Adults Over 65 Years Are Eligible for Medicare
Medicare Eligibility You may be eligible for Medicare if:
- You are age 65 or older.
- You are younger than 65 and have a disability.
- You are younger than 65 and have end-stage renal disease (permanent kidney failure that requires dialysis or a transplant) or ALS (also called Lou Gehrig’s disease).
Medicare health insurance can help cover the cost of inpatient or outpatient drug and alcohol treatment.
Many people in this age group and persons with disabilities will, unfortunately, suffer from substance abuse disorders, addiction, drug dependency, or mental health problems. It can be hard for someone to afford treatment when they are retired or not working or when someone is struggling with a disability. Medicare health insurance helps those people in these positions get the proper help they need.
Not every drug treatment program in California will take Medicare, but Present Moments Recovery does. It is important for anyone struggling with a drug or alcohol addiction in the state to get the right help they need.
What is Medicare/Federal Insurance?
An increasingly used method for paying for drug and alcohol rehab, Medicare is a federal-funded health insurance programs. This insurance program can provide free or low-cost drug and alcohol addiction treatment.
Medicare may cover part or all of your substance abuse treatment costs.
A Shocking Percentage Of The California Population Needs Drug And Alcohol Treatment
Within the state of California, the opioid overdose epidemic is killing over 6,000 people annually , and that means about 17 people die each day. The total of overdose deaths are above 96,000 annually, and untold suffering is experienced by those who continue their active addiction.
Medicare can be used to cover the cost of drug and alcohol rehabilitation. But there are rules about the providers people can use with Medicare, and some types of addiction treatment are not covered by Medicare at all. It’s a good idea to contact us directly to find more detailed information.
At Present Moments, we work with Medicare-qualified patients to get the help they need for their substance use disorder (SUD) or alcohol use disorder (AUD), medical conditions defined by an uncontrollable use of alcohol or other substances despite negative consequences. If you or someone you love is battling a SUD or an AUD and qualifies for Medicare benefits, please reach out to one of our admissions counselors at (619) 363-4767.
Of course, navigating Medicare can be confusing. The following information covers the basics of using Medicare to access drug treatment.
Is Medicare a PPO, HMO, or Something Else?
Medicare is a nationwide insurance plan offered by the federal government. It’s different from private insurance in that it doesn’t offer plans for families or couples. Individuals elect how they want to get their Medicare health coverage, which includes one of the following choices
- Original Medicare: This health plan includes hospital insurance (Part A) and medical insurance (Part B). When individuals receive a covered service or treatment, Medicare pays part; the individual pays the rest, and individuals can see any doctor anywhere, provided they accept Medicare. Prescription coverage requires the addition of a Medicare drug plan (Part D).
- Medicare Advantage Plan: This Medicare-approved health plan comes from a private company chosen by the individual for their health and drug coverage. In most cases, doctors need to be in the plan’s network, and many of these plans cover prescriptions, vision, hearing, dental, even gym memberships, too. Under the Medicare Advantage Plan, individuals have PPO, HMO, Private Fee-for-Service Plans (PFFS), and Special Needs Plan (SNP) options.
- Medicare PPO plans have a network of health care providers, doctors, and hospitals. Individuals may receive covered services and treatments from out-of-network specialists, but that tends to come at a higher cost. Emergency and urgent care services are always covered.
- Medicare HMO plans require individuals to seek care from in-network health care providers and doctors except for emergency care, out-of-network urgent care, and out-of-area dialysis. Many HMO plans offer prescription drug coverage, but it’s important to confirm that it does because if the HMO plan you choose doesn’t offer prescription drug coverage, you can’t join a separate Medicare drug plan.
- Medicare PFFS plans are offered by private insurance companies that determine how much they will pay health care providers, doctors, and hospitals and how much you will pay for care.6
- Medicare SNPs limit membership to individuals with specific diseases or conditions. To join, you need to have Medicate Part A (hospital insurance), Part B (medical insurance), live in an area the plan services, and have a severe condition like chronic alcohol or other substance dependence.
More About Using Medicare for Addiction Rehabilitation in San Diego
Understanding precisely what Medicare covers regarding addiction treatment can be difficult, so it never hurts to pick up the phone and call us at (619) 363-4767 to speak directly with an intake counselor who can help .
Present Moments Recovery is proud to be a preferred provider who takes Medicare insurance. This means if you have Medicare insurance, they typically pay a higher percentage of treatment costs since Present Moments Recovery is a preferred provider. With Medicare, you’re likely able to receive coverage for addiction treatment and can be covered up to 100% depending on your plan and deductible.
Clinical, Effective, & Comprehensive Drug Rehab
Present Moments Recovery is passionately dedicated and committed to the treatment of adults with a substance use disorder. We are DHCS & CARF licensed and accredited and have two locations in San Diego County, in Carlsbad and San Marcos.
We provide multiple levels of ASAM care for the substance use disorder spectrum:
|o Detoxification and Stabilization||o Intensive Outpatient Treatment|
|o Residential Treatment||o Outpatient Treatment|
|o Partial Hospital Treatment||o Medication Assisted Treatment (MAT)|
In addition to our ASAM levels of treatment, we also perform Interventions, SUD Assessments, Urine Screening, and have a Family Support Educational Program.
At Present Moments Recovery our treatment programs are flexible, providing daytime and evening treatment options (Monday-Friday) to accommodate the schedules of our adult clients. We have a maximum of only 10 clients in each track of our PHP, IOP, OP levels of care and 6 in our Residential Treatment to preserve quality of care.
Examples of Treatment Activities:
- Cognitive Behavioral Therapy
- Motivational Interviewing
- Expressive Therapies: Art Therapy, Music Therapy, and Journaling
- Individual Therapy Sessions
- Dialectical Behavioral Therapy
- Group Therapy
- Somatic Therapies: Mindfulness and Qigong
- Holistic Processes: Yoga, Meditation, Physical Fitness, Acupuncture and Nutrition
Our Psychoeducation sessions focus on the components that will support lasting recovery: Understanding SUD, Relapse Prevention, Identification of Triggers, Healthy Coping Skills, Establishing a Sober Support System, Clear Communication Skills, Managing High Risk Situations, Healthy Leisure Activities, Self-Care, and Stress Management.
The Present Moments Recovery Clinical Team is comprised of a MD Medical Director, PA’s, Licensed Marriage and Family Therapists, Licensed Social Workers, Licensed Clinical Addiction Specialists, CADC II, and Registered Alcohol and Drug Technicians who each bring their passion and commitment to providing best care for every client.
Clinically Effective Addiction Treatment in San Diego Covered by Medicare
We’re committed to helping Medicare members achieve long-term recovery through an interdisciplinary approach that aims to strengthen the mind-body-spirit connection.
Medicare covers not only substance use disorder treatment, but also treatment for other mental health conditions, and may cover drug detox, inpatient or residential addiction programs, and outpatient addiction programs.
Help with Health Insurance
This graphic is great to explain deductibles. Click here for full document.
This graphic contains helpful Insurance Terminology, click here for the full document.
Medicare plans are all very different; but many plans will cover mental health, behavioral health, and distribution treatment services. These include:
- Hospital treatment
- Inpatient treatment
- Office visits
- Outpatient treatment
- Partial day treatment
- Psychological testing
- Residential treatment
Verification will be required prior to admitting to a drug treatment program offered through Medicare. Outpatient and inpatient treatment services will usually include relapse prevention skills training, educational programs, therapy, medical and mental health care, support groups, detox services, and medication management.
One of the roadblocks in obtaining precise information regarding what is not covered by Medicare is the medical necessity issue. The therapist or physician who determines that residential treatment is necessary might need to provide an addiction diagnosis to the insurance provider, proving it is a medical necessity.
Unfortunately, physical dependence and withdrawal symptoms are usually not enough proof that residential treatment is a medical necessity. The increased risk of relapse during outpatient treatment will not guarantee approval for inpatient treatment. In some instances, patients will need to prove that outpatient treatment won’t work for their situation, or they might be required to utilize it first if they want their insurance to cover the cost.
Clients will also benefit if they proactively get pre-authorization for the therapy services needed before they begin treatment to guarantee that their insurance company covers them.
Covering Additional Rehab Costs
Even in the best-case scenario, most health insurance policies do not cover the entire cost of detox and residential treatment. Clients will be responsible for coming up with the remainder of the bill. Although this may sound overwhelming, especially when someone involved is suffering from addiction, it could be a life-saving decision.
Many people side step using health insurance to solely cover the cost of addiction treatment because it delays the admissions to rehab or because the effort doesn’t equate the time put in. Instead, people will utilize various resources to cover treatment costs.
Get Help Today
Do not hesitate to inquire into substance abuse treatment any longer. At Present Moments, our admissions specialists are here to ensure that you receive all of the financial help you are entitled to with your Medicare health insurance plan.
Present Moments is in-network with Medicare. Therefore, we will work collectively to make substance abuse treatment coverage possible and convenient. Our treatment team understands the importance of catering to the patient’s treatment while budgeting simultaneously.
If you or a loved one requires a rehab but is still uncertain you can afford it, contact us today for a free consultation. Our admissions specialists will answer any of your questions by getting you the answers you seek regarding your Medicare addiction treatment coverage options.
Contact our intake department at (619) 363-4767 to discuss your situation.