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Medicare Drug Cost Reduction Poorly Received; Meet Medicare, Medicaid, and Addiction Treatment: Are You Covered? What You Need to Know

  • Medicare Drug Cost Reduction Poorly Received; Meet Medicare, Medicaid, and Addiction Treatment: Are You Covered? What You Need to Know

    Medicare Drug Cost Reduction Poorly Received; Meet Medicare, Medicaid, and Addiction Treatment: Are You Covered? What You Need to Know

    Update 5/25
    The Obama Administration is proposing to reduce medicare drug payments on several prescription drugs. The proposal is meeting sharp opposition in argument the plan serves to cut costs of basis medications- and not improve the quality of life for patients. For instance, under the new proposal, cancer medication may be more difficult to get, according to the New York Times 300 House members, 14 republicans and 12 democrats are questioning the usefulness of the proposal.  
    The new payment model may begin on the 1st of August. The secretary of health and human services, Sylvia Burwell says the proposal will encourage doctors to prescribe less expensive medications to patients.
    The proposal is intended to help patients cut costs on medications, yet several democrats believe it will have an opposite effect, where people with Medicare B will incur 20% of the charges on several thousand dollar medications.

    ———————

    “Thanks Obama,” may as well become the nation’s national war cry since we belly-ache so much about the newly imposed healthcare requirements, and subsequent penalties in absence of coverage. Give it time, reform may revitalize the program to make policies more sustainable. (We hope.)

    The problem with Medicaid, despite its wonderful intentions, is people in need of addiction treatment are running into barriers that shouldn’t exist; mainly, the insistence of outpatient rehabilitation treatment as the first line of healthcare for chronic addiction. Everything we know about treatment discredits outpatient rehabilitation as the primary defense against addiction, which almost inevitably guarantees relapse.

    The only people who may benefit from outpatient rehab initially are those who have not yet developed chronic addiction, and who have a safe and supportive home environment.

    And let’s get one thing straight: Medicare and Medicaid are not synonymous. While it’s true there are some who qualify for both programs, there are plenty who only fit into one or the other. Here’s a quick breakdown of both:

     

    Medicaid for Addiction Treatment & Everything Else

    • Federally funded
    • Supports low income families and individuals
    • Inpatient & Outpatient services covered
    • Personal care
    • Optometry care
    • Dental care
    • State run: states determine covered services

     

    Mandatory Benefits of Medicaid Include:

    • Inpatient and outpatient treatment
    • Screening, treatment, and diagnosticsMedicare Drug Cost Reduction Poorly Received; Meet Medicare, Medicaid, and Addiction Treatment: Are You Covered? What You Need to Know image
    • Nursing facility care
    • Home health care
    • Doctor’s services
    • Rural health clinics
    • X-ray and laboratory screening
    • Family planning services
    • Midwife services
    • Freestanding Birth Center services
    • Pediatric and Family Nurse Practitioner services
    • Tobacco cessation counseling for expectant mothers

     

    Medicare for Addiction Treatment & Everything Inbetween

    • Federally funded
    • Available to U.S. citizens and legal residents aged 65 or older
    • Supports low income families and individuals
    • For Part A inclusion, individuals or spouses must have worked for 10 years and paid Medicare taxes during employment
    • Medicare Part B requires individuals pay a premium

     

    Those younger than 65 may qualify for Medicare if:

    • Eligibility is dependent on routine dialysis, kidney transplants
    • Receipt of 24 months of Social Security Disability or disability pension from the Railroad Retirement Board (RRB)
    • Diagnosed with Lou Gehrig’s Disease

     

    Addiction Treatment with Medicaid

    Now that all of the exposition is out of the way, and you hopefully have a better understanding of the two programs, we can talk about what’s important for addiction treatment.

    This comes straight from the Addiction Center:

    Medicaid is a public insurance program for low-income families. Under the 2010 Affordable Care Act (ACA), also known as “Obamacare,” insurance providers (including Medicaid) must cover all basic aspects of addiction treatment. While Medicaid covers addiction treatment, not all addiction treatment centers accept Medicaid as a form of payment.

    Medicare Drug Cost Reduction Poorly Received; Meet Medicare, Medicaid, and Addiction Treatment: Are You Covered? What You Need to Know imageUnfortunately many private rehabilitation facilities are not financially equipped to accept medicaid; essentially, for rehab centers most government programs are not fiscally sustainable for their practice. It comes with the territory of needing to fund their own treatment equipment, front the bills for employees, pay for marketing efforts, and all the other things that go into running a successful and ethical rehab center.

    You may question the “ethics” of rehabilitation centers who don’t accept medicaid– but you’d be surprised how many employees who work at those facilities are heartbroken about denying services to those in need.  In many cases rehab centers will try to connect people in need with state funded resources.

    Fortunately, many rehab centers are making the push to accept medicaid in the future for addiction treatment, like Harbor Village. It’s all a transitory process.

    But what does that mean for people who need help now?

     

    Check out this list of Rehab Centers Accepting Medicaid by state.

     

    Make sure you read up on What You Need to Know About Insurance Agencies & Outpatient Rehab!

     

    Feel free to ask us any questions about rehab treatment with Harbor Village! We have partners all over the nation.

     

    Further Reading:

    Understanding the Dry Drunk & Abstinent Addict (And Why They’re Not Recovered)

    How to Pass a Drug Test in 7 Steps

    5 Tips for Preparing for a Rehabilitation Program

    Drug Treatment Centers in Florida

    Consider Substance Abuse Counselor Jobs

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