Category: Medicare

Tips for Navigating the Medicare System

Ask ahead of time if your treatment will be covered. suggests checking that your treatment will be covered before you begin it. You can do so by calling 1-800-MEDICARE.

Understand what “reasonable and necessary” means. As an article from The New England Journal of Medicine notes, the “reasonable and necessary” clause has been part of the Medicare policy since it began in 1965. It takes a look at how the Centers for Medicare and Medicaid Services define “reasonable” and “necessary,” respectively, and educates readers about possible discrepancies.

Know that certain facilities aren’t covered. Medicare has specific requirements for the kinds of medical organizations it will approve for addiction recovery. AddictionBlog advises that detox clinics or other facilities that aren’t connected to a general or psychiatric hospital may not be covered.
Know that if you’re not covered by Medicare, you can get covered. If you are 65 or older, you will be automatically enrolled. However, if you are younger than 65, it is possible to get coverage if you meet certain criteria. Contact the Social Security Administration to find out if you are eligible.

Be aware of the psychiatric hospital limit. The National Association of Psychiatric Health Systems explains that Medicare still enforces a 190-day lifetime limit on inpatient psychiatric care. The limit applies to stays at psychiatric facilities that are not connected to general hospitals.

Take advantage of preventive screening. As this informational piece from CMS explains, Screening, Brief Intervention, and Referral to Treatment Services (SBIRT) are covered. The program acts as a preventive method for catching alcohol and drug abuse in its early stages.
Seek treatment facilities with programs for seniors. When seeking an addiction recovery program, it’s important that you find one whose staff includes physicians, registered nurses, psychiatrists, counselors, and other medical professionals who understand the specific recovery needs that come with geriatric care.


Are you mixing your prescription medicines with alcohol? The National Council on Alcoholism and Drug Dependence notes that a common sign of prescription drug abuse among seniors is mixing drugs that shouldn’t be taken together and/or taking pills with alcohol.
Are you drinking more than 3-4 drinks per day? According to the National Institute on Alcohol Abuse and Alcoholism, women who drink more than 3 drinks per day or men who drink more than 4 drinks per day may be at risk for an Alcohol Use Disorder (AUD).

Are you having trouble sleeping or sleeping more during the day? Health in Aging notes that changes in sleep patterns in an older person are an early sign of prescription drug misuse or alcohol abuse.

Have you visited multiple doctors to get prescribed the same medication? The National Institutes of Health’s website for seniors explains that “doctor shopping” in order to get several of the same prescription is a sign of substance abuse and dependency.
Are you having trouble balancing? If you’re having balance issues or have fallen recently, the American Osteopathic Association says drug or alcohol abuse could be contributing to these issues.

Are you having memory problems? Often, signs that an elderly person is abusing drugs or alcohol are simply attributed to old age. However, the New York State Office of Alcoholism and Substance Abuse Services notes that sometimes certain issues, such as trouble remembering, are being caused by substance abuse.

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