Does Medicaid or Medicare Cover Sober Living?

Making it this far in your recovery journey is a huge accomplishment. Often, after completing an addiction treatment program, many transition into aftercare post recovery options, including sober living homes. The road to recovery and lasting sobriety can be filled with challenges, one of which is figuring out if Medicaid/Medicare can cover sober living costs. However, these challenges can be beat.

What Does Medicare and Medicaid Cover?

Let’s break down Medicare and Medicaid health coverage.

Medicare Coverage

Medicare offers health care coverage primarily for those over 65. Medicare will pay for treatment of alcoholism and substance use disorders in both inpatient and outpatient settings. Medicare Part A pays for inpatient substance abuse treatment; individuals will pay the same co-pays as for any other type of inpatient hospitalization. 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.

Medicaid Coverage

Medicaid and the Children’s Health Insurance Program (CHIP) provide affordable health coverage to eligible low-income adults, children, and people with disabilities. Medicaid in all states covers some mental health services, and many provide services for substance use disorders as well. They typically include counseling, therapy, medication assisted treatment (MAT), peer services, and various levels of care for addiction treatment. However, It’s important to check your specific plan and state regulations for detailed information.

Does Medicare or Medicaid Cover Sober Living Homes?

Law reforms like the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) have required health plan companies to provide insurance coverage for rehab. This coverage can include different levels of care for substance use disorders. While Medicaid and Medicare provide substantial support for various aspects of addiction treatment, their coverage for sober living expenses can vary.

Medicare, primarily for those over 65, usually doesn’t cover sober living. But, some Medicare Advantage plans might offer help. Medicaid, for people with limited income, is a different story. While it does cover substance abuse treatment under the Affordable Care Act, the coverage for sober living homes varies significantly between states. It’s not a one size fits all situation.

State Specific Medicaid Coverage for Supportive Housing

Medicaid’s coverage for sober living varies by state meaning different states have different rules regarding Medicaid coverage for supportive housing. For instance, in states like California, New York, and Illinois, Medicaid programs may include some form of assistance for sober living environments. Each state has its own set of rules and coverage options, so it’s crucial to investigate your state’s specific Medicaid program. 

Exploring Alternative Financial Support for Sober Living

Medigap, also known as Medicare Supplement Insurance, is designed to fill the gaps in traditional Medicare coverage. For those in recovery, Medigap can be a helpful tool. While it doesn’t directly cover sober living expenses, it can alleviate the financial burden by covering out of pocket costs for Medicare approved treatments. This includes copayments, coinsurance, and deductibles for services like substance abuse treatment, which is often a critical component of the recovery process

Beyond government programs, many individuals find support through scholarships offered by sober living homes, sliding scale fees based on income, and assistance from local nonprofits. These resources can provide essential support for maintaining sobriety in a stable living environment.

Your Path to Supported Sobriety

Navigating the financial aspects of sober living is a critical part of the recovery journey. Whether it’s through Medicare, Medicaid, Medigap, or other financial resources, there are avenues available to support your sobriety. Stay informed, explore all options, and remember, each step forward is a step towards a healthier, sober life.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-953-3913 (Who Answers?) today to learn about your treatment options.