Over the last two decades, the overdose death rate among adults over 65 has quadrupled, yet Medicare fails to cover the full range of evidence-based addiction treatment. As of 2023, about 6.4 million Medicare beneficiaries nationwide were living with a substance use disorder, with 1.9 million having opioid use disorder. More than 25,000 beneficiaries in Illinois had opioid use disorder. According to the U.S. Department of Health and Human Services, less than 1 in 5 of all Medicare beneficiaries with opioid use disorder received medication to treat it, and in Illinois the rate was even lower.
The American Society of Addiction Medicine defines four levels of care for substance use disorders: outpatient services, intensive outpatient programs, non-hospital-based residential treatment, and intensive inpatient hospitalization. Traditional Medicare covered only the extremes—basic outpatient services and hospital-based inpatient care—leaving a dangerous gap in the middle. In January 2024, Medicare began covering intensive outpatient programs (Level 2), but non-hospital-based residential treatment (Level 3) remains excluded. Level 3 provides the full range of clinically necessary services for individuals with intensive needs in residential settings and serves as both an entry point for people in crisis and a step down for patients no longer needing 24-hour hospital care.
The Residential Recovery for Seniors Act, first introduced in 2024 by U.S. Rep. Lauren Underwood, D-Illinois, is a bipartisan bill designed to address this coverage gap by establishing a new Medicare Part A benefit for residential addiction treatment programs. Without coverage for residential care, older adults are forced to pay out of pocket, often accumulating tens of thousands of dollars in medical debt, or they forgo appropriate treatment and cycle through emergency rooms and hospitals. This approach is both ineffective at sustaining recovery and more expensive than planned, evidence-based treatment.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://chicago.suntimes.com/other-views/2026/04/08/medicare-adults-65-drug-substance-use-disorders-coverage-deborah-steinberg-gerald-jud-deloss