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How Can AARP Pay for Rehab?

aarp-2According to the National Institute on Drug Abuse (NIDA) and the National Council on Alcoholism and Drug Dependence, it is estimated that 2.5 million senior citizens have alcohol or drug abuse issues. Approximately 14 percent of admissions to emergency rooms involving senior citizens are due to drug or alcohol issues, and nearly half of nursing home residents have a drug or alcohol problem.

The most common drug of abuse among the elderly is alcohol followed by prescription medications, particularly benzodiazepines and pain medications. Overall, alcohol and drug abuse in elderly individuals is often underdiagnosed. As a result, more resources should be allocated to research and treatment of individuals over the age of 65 who have drug or alcohol abuse issues.

Even though as a group individuals over the age of 65 make up less than 15 percent of the population, they account for nearly 30 percent of all prescriptions for medications that are written in the United States. Individuals over 65 years old have lower rates of substance use disorders than most other age groups; however, they do develop substance use disorders and require intensive and targeted treatment for these conditions.

Elderly individuals who have substance use disorders may have had substance abuse issues for years or have developed issues with substance abuse as a result of complications and stresses associated with getting older.

Some of the driving issues that can contribute to substance abuse problems in the elderly include:

  • The loss of a significant other, family members, and close friend, which can lead to loneliness, isolation, and problems confronting one’s own mortality
  • Idleness and feeling unfulfilled as a result of retirement
  • Declining physical health
  • Declining mental health, including issues with cognition and/or mood
  • Financial issues
  • Placement in a residential facility or nursing home

Because the majority of these individuals are on fixed incomes, it is often important that they are able to rely on insurance and insurance supplements to assist them.

AARP

The American Association of Retired Persons (now AARP, Inc.) was founded in 1958 with a mission to enhance the quality of life for individuals as they age. AARP advocates for positive social change for elderly individuals through its major organization and several different affiliated organizations.

AARP has a vast membership and generates its own revenues via membership plans, supplementary insurance plans, and advertisements placed in its publications. AARP is also an extremely powerful lobby group.

Insurance through AARP

Insurance programs offered through AARP fall under the sub-organization title “AARP insurance plans.” AARP does not offer its own healthcare plan, but members can get discounts as part of AARP.

For example:

  • Members can get prescription discounts through Catamaran.
  • Members can become involved in a hearing care program through HearUSA.
  • Discounts associated with vision care are offered through EyeMed.
  • AARP offers vision insurance and a dental insurance plan through Delta Dental.

With respect to health insurance, AARP offers access to supplemental insurance for Medicare and resources to help individuals who have Medicare.

Medicare is a federally funded government insurance program that provides insurance coverage for people who are over the age of 65 or who have specific types of disabilities. Individuals pay monthly premiums that are based on their income level.

  1. Part A provides inpatient treatment benefits, including inpatient treatment for psychiatric purposes (e.g., rehab). Medicare typically covers inpatient rehab treatment for 60 days without a copayment, but there are also other conditions associated with the care.
  2. Part B covers outpatient treatment that would include therapy for substance abuse and medication in some cases. Part B typically covers 80 percent of these expenses, leaving 20 percent to be covered by the individual.
  3. Part C provides more extensive coverage for individuals who wish to pay more for such coverage. This is an optional program.
  4. Part D covers the partial cost of prescription medications.

AARP provides its members with numerous resources regarding Medicare. In addition, AARP offers access to a Medicare Advantage Program, which qualifies under Medicare Part C. AARP labels this program the AARP Medicare Complete Plan, and it is administered by United Healthcare. This supplemental program can pick up part of the costs Medicare will not cover.

These supplemental programs consist of the following:

  • Health maintenance organizations (HMO) require participants to use services from providers that are within a specific network of providers. HMOs are typically less expensive than other plans, but obviously limited regarding access to providers. For instance, in an HMO, therapists must be part of the network or coverage is not provided.
  • Point of service (POS) plans allow members to use out-of-network providers but at higher costs. POS plans typically have much higher out-of-pocket costs than HMO plans.
  • Preferred provider organization (PPO) plans allow members to see both out-of-network and in-network providers. These plans have the highest out-of-pocket costs compared to HMOs or POS plans.

United Healthcare provides coverage for a variety of rehab services.

  • Inpatient withdrawal management (medical detox) is covered during the acute withdrawal phases. The treatment is subject to coverage if it is deemed to be medically necessary for the individual. According to their website, five days of medical detox are covered per episode. There is no limit on the number of treatment episodes. The treatment that must be deemed medically necessary is the inpatient component of the withdrawal management program.
  • Inpatient rehabilitation services are covered and limited to 190 days over an individual’s lifetime in freestanding psychiatric hospitals.
  • Outpatient withdrawal management is covered. Based on the criteria from the website, it appears that this would be much easier to get approved than inpatient withdrawal management services.
  • If chemical aversion therapy, the use of chemicals to create aversive states that can help to avoid relapse during recovery, is deemed medically necessary, it may be covered.
  • Outpatient treatment/rehabilitation is also covered.

Treatment is only approved if it is deemed as medically necessary. Medicare has its own specifications when determining which treatments for what conditions are justified as medically necessary.

For example, Medicare considers the use of methadone as a treatment for pain a covered treatment, but the use of methadone to treat substance abuse may not be covered under Part D; however, it may be covered under part A when a person is in an inpatient withdrawal management program.

In addition, as AARP offers Medicare supplemental insurance to its members, it is important for individuals with Medicare and AARP supplemental insurance to ensure that a treatment facility accepts Medicare. The standards used by Medicare to judge medical necessity are typically pretty inflexible; however, medical necessity is determined on a case-by-case basis. Individuals who have physician referrals for rehab are more likely to get approval than individuals who have a therapist or social worker make such referrals.

Typically, Medicare services and coverage need to be confirmed before an individual can start treatment at a specific facility. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a treatment provider locator that individuals can use to find specific substance use disorder treatment facilities in their area that accept specific types of insurance. This treatment locator tool can be used to find facilities near the individual that accept Medicare and the Medicare supplemental insurance that is offered through AARP.