What Recovery Care Costs on Medicare: Deductibles, Coinsurance and Medigap

Most recovery care that Medicare covers comes with some cost-sharing. For outpatient services under Part B, you generally pay the yearly deductible ($283 in 2026) and then 20% of the Medicare-approved amount. Hospital stays under Part A carry their own deductible. A Medigap policy can pick up much of that, and Medicare Advantage plans set their own rules. There are two notable exceptions: the copayment for opioid use disorder treatment at an opioid treatment program is $0, and the yearly alcohol misuse screening is $0 when the provider accepts assignment.

Below are the 2026 numbers, a simple worked example and the costs Medicare generally doesn't pay for. It's written for people on Medicare and for the adult children helping them make sense of a bill.

The 2026 numbers that matter most

These figures come from the Centers for Medicare & Medicaid Services (CMS 2026 premiums and deductibles).

Part B (outpatient care)

• Standard monthly premium: $202.90

• Yearly deductible: $283

• After the deductible: generally 20% of the Medicare-approved amount for most services (Medicare.gov)

Part A (inpatient hospital care)

• Deductible: $1,736 per benefit period, which covers your share of days 1 through 60 of a hospital stay

• Days 61 through 90: $434 per day

• Lifetime reserve days (extra days you can use once in your lifetime after day 90): $868 per day

A benefit period starts when you're admitted to a hospital and ends after you have gone 60 days in a row without inpatient hospital or skilled nursing care. If you're admitted again after that, a new benefit period and a new deductible begin.

One more limit applies to psychiatric care. Part A covers up to 190 days in a freestanding psychiatric hospital over your lifetime. That limit doesn't apply to psychiatric care in a general hospital (Medicare.gov, Inpatient mental health care).

Where the 20% shows up in recovery care

Most outpatient recovery services fall under Part B, so the deductible and 20% coinsurance are what you will see most often. That includes:

• Individual and group therapy, and family counseling when the goal is to help with your treatment (Medicare.gov, Outpatient mental health care)

• Intensive outpatient program (IOP) services, where hospital outpatient departments and community mental health centers may also charge a per-day coinsurance (Medicare.gov, IOP)

• Behavioral health integration, where your primary care practice manages your behavioral health care each month with your agreement (Medicare.gov, BHI)

• Recovery coaching delivered as peer support navigation, known as Principal Illness Navigation, Peer Support (PIN-PS), where the usual Part B deductible and coinsurance apply (CMS FAQ, PDF)

• Doctor visits to prescribe and monitor medication such as buprenorphine outside an opioid treatment program

Our guides to counseling, intensive outpatient programs and recovery coaching explain each benefit in more depth.

The two exceptions

The first is opioid treatment. Under Original Medicare, the copayment for opioid use disorder treatment at an opioid treatment program (OTP) is $0. The Part B deductible still applies. If you get similar services from a doctor outside an OTP, the usual copayments or coinsurance and deductible apply (Medicare.gov, OUD treatment). See does Medicare cover Suboxone and methadone.

The second is alcohol screening. Medicare covers one alcohol misuse screening a year for adults who drink but don't meet the criteria for alcohol dependence. If the screening shows misuse, Medicare covers up to four brief face-to-face counseling sessions a year in a primary care setting. You pay $0 if the provider accepts assignment, which means the provider agrees to take the Medicare-approved amount as full payment (Medicare.gov, Alcohol misuse screenings and counseling). If you're worried about a parent's drinking, this is a reasonable place to start. Our guide on signs your parent has a drinking problem may help you prepare.

How Medigap changes what you pay

Medigap, also called Medicare Supplement Insurance, is private coverage that works alongside Original Medicare and pays some of the costs Medicare leaves to you. Plans are identified by letter, and the benefits for each letter are standardized. For Part B coinsurance, Medicare's comparison chart shows:

• Plans A, B, C, D, F, G and M pay 100% of Part B coinsurance

• Plan K pays 50%, and Plan L pays 75%

• Plan N pays 100%, except for copayments of up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission

Plans K and L have yearly out-of-pocket limits, which in 2026 are $8,000 for Plan K and $4,000 for Plan L (Medicare.gov, Compare Medigap plan benefits). Plans C and F are available only to people who were eligible for Medicare before 2020.

You can't use a Medigap policy with a Medicare Advantage plan. Medigap only works with Original Medicare.

A worked example, with illustrative numbers

The figures below are made up to show how the math works. They aren't real prices for any service.

Say a recovery-related service has a Medicare-approved amount of $100 per session, and you have Original Medicare.

• Early in the year, before you've met the deductible, you pay the full $100 for that session, and it counts toward your $283 Part B deductible.

• Once you've met the deductible, Medicare pays 80%, or $80. Your 20% coinsurance is $20.

• With Medigap Plan G, the policy pays that $20 coinsurance. Plan G doesn't pay the Part B deductible, so the earlier sessions that went toward the deductible are still yours.

• With Medigap Plan K, the policy pays half of the coinsurance, so you pay $10 for the session.

• With Medigap Plan L, it pays 75% of the coinsurance, so you pay $5.

Weekly sessions add up over a year, so it helps to run this math with the real Medicare-approved amount before you start. A provider's billing office can usually tell you what that amount is for the services they plan to bill.

Original Medicare or Medicare Advantage for recovery care

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, including every Medicare-covered OTP service. What differs is how you get the care and what you pay for it (Medicare.gov, Compare Original Medicare and Medicare Advantage).

Start with networks. With Original Medicare, you can see any provider in the country who accepts Medicare. A Medicare Advantage plan may require you to use providers in its network, including an in-network OTP.

Medicare Advantage plans can also require a referral or approval in advance (prior authorization) before they pay for some services. If a program says it's covered, ask whether anything needs approval first.

The costs themselves can differ too. Medicare Advantage plans set their own copayments and coinsurance, which can differ from the 20% under Original Medicare. Look up each service in the plan's Evidence of Coverage, or call the number on the member card.

Neither option is better for everyone. Original Medicare with a Medigap plan tends to mean more provider choice and more predictable bills, while Medicare Advantage usually comes with more rules about where you go. For recovery care specifically, the right question is whether the providers you want are covered and what you will pay at each one.

Medications and Part D

Prescription drugs you fill at a pharmacy are covered through a Part D plan, or through a Medicare Advantage plan that includes drug coverage. Part D may cover buprenorphine and naltrexone, as well as naloxone and nalmefene for reversing an overdose. Methadone for opioid use disorder isn't covered under Part D; it's covered only at an OTP under Part B or during an inpatient stay under Part A (Medicare, Opioid Use Disorder Treatment Services, PDF).

Each Part D plan has its own list of covered drugs, called a formulary, and its own copays. Before filling a prescription, check that the exact drug and form is on the formulary and which pharmacies are in network.

What Medicare generally doesn't pay for

Some costs in recovery fall outside Medicare. Original Medicare generally doesn't pay for room and board at residential programs or for sober living homes. Medicare's mental health booklet also lists meals, transportation, support groups and private rooms among the things it doesn't cover (Medicare & Your Mental Health Benefits, PDF). Medicare also generally doesn't pay for remote alcohol monitoring devices or for a private sober coach you hire on your own.

Inpatient care has limits too. Medicare covers hospital detox when complications require a hospital setting, generally for two to three days and occasionally up to five, and inpatient rehabilitation when less intensive treatment has not worked or other medical conditions require hospital care (CMS, NCD 130.1). Our guide on whether Medicare covers rehab goes into this. If a parent drinks heavily or takes benzodiazepines, stopping suddenly can be dangerous, so talk to a doctor before they quit.

Questions to ask before starting

• Do you accept Original Medicare, and do you accept assignment? Or are you in network with my Medicare Advantage plan?

• What is the Medicare-approved amount for the services you plan to bill, and how often will they be billed?

• Have I met my Part B deductible this year?

• Does my Medigap policy cover the coinsurance, and how much of it?

• Does my Medicare Advantage plan need a referral or prior authorization for this?

• Are any parts of the program billed privately rather than to Medicare, such as housing, meals or devices?

For the full list of covered recovery services, see our pillar guide, what Medicare covers in recovery.

Common questions

What is the Part B deductible in 2026?
It's $283 for the year. After you meet it, you generally pay 20% of the Medicare-approved amount for most Part B services.

Does Medigap cover the 20% for therapy or recovery coaching?
Plans A, B, C, D, F, G and M pay all of the Part B coinsurance. Plan K pays half, Plan L pays 75% and Plan N pays all of it except certain office and emergency room copays. Medigap doesn't work with Medicare Advantage.

Is anything in recovery care covered without a copayment?
Two things stand out. Under Original Medicare, the copayment for opioid use disorder treatment at an OTP is $0, although the Part B deductible still applies. The yearly alcohol misuse screening, and up to four brief counseling sessions if needed, are $0 when the provider accepts assignment.

Does Medicare pay for sober living?
Original Medicare generally doesn't pay for sober living homes or for room and board at residential programs.

Does Medicare Advantage change what I pay for recovery care?
It can. Medicare Advantage plans must cover everything Original Medicare covers, but they set their own copayments and coinsurance and may require in-network providers or prior authorization. Check the plan's Evidence of Coverage or call the plan before starting.

Where Accountable fits

Accountable offers recovery coaching through Medicare in Florida, New Jersey, New York, North Carolina, Tennessee and Texas. A certified recovery coach works with you by video or phone, with a licensed clinician from one of our Insurance Offering Partners (the medical groups that provide clinical services through Accountable) evaluating and overseeing your care. Medicare may cover these sessions as peer navigation under its PIN-PS benefit when the clinician finds a qualified clinical need at an initiating visit. It is session-based and separate from Accountable's monthly subscription. The usual Part B deductible and coinsurance apply, and what you pay depends on your plan (Original Medicare or Medicare Advantage) and any secondary coverage such as a Medigap plan. Your plan makes the final call on coverage. You can start the process for a parent or spouse, and they go through the same clinician visit. Learn more at Recovery coaching through Medicare or call (646) 450-7641.

Sources

• Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B Premiums and Deductibles.

• Medicare.gov. Mental health care (intensive outpatient program services).

• Medicare.gov. Mental health care (inpatient).

• Medicare.gov. Mental health care (outpatient).

• Medicare.gov. Behavioral health integration services.

• Centers for Medicare & Medicaid Services. Health-Related Social Needs FAQ (PDF).

• Medicare.gov. Opioid use disorder treatment services.

• Medicare.gov. Alcohol misuse screenings and counseling.

• Medicare.gov. Compare Medigap plan benefits.

• Medicare.gov. Compare Original Medicare and Medicare Advantage.

• Centers for Medicare & Medicaid Services. Medicare Coverage of Opioid Use Disorder Treatment Services (PDF).

• Centers for Medicare & Medicaid Services. Medicare & Your Mental Health Benefits (PDF).

• Centers for Medicare & Medicaid Services. National Coverage Determination 130.1 (inpatient hospital stays for alcohol detoxification and rehabilitation).

This guide explains Medicare rules in general terms and is not legal, medical or billing advice. Coverage depends on your plan and your situation. Last reviewed October 2026.