Yes, Medicare coverage for intensive outpatient programs (IOP) is available under Medicare Part B (Medical Insurance). This coverage is provided when the treatment is deemed medically necessary and the program is administered at a Medicare-approved facility, such as a certified outpatient mental health center or a hospital outpatient department.

To access these benefits, several requirements must be met:

• Physician Certification: A doctor must certify that you require structured outpatient treatment that exceeds standard weekly therapy sessions.
• Treatment Plan: Care must be supported by an individualized, written treatment plan that outlines specific recovery goals.
• Medical Necessity: Coverage is subject to eligibility and ongoing clinical reviews to document the continued need for care.

Out-of-Pocket Costs for 2026

While the specific deductible for 2026 has not yet been finalized by Medicare (the 2025 deductible is $233), the cost-sharing structure remains consistent:

1. Deductible: You must first meet your annual Part B deductible.
2. Coinsurance: After the deductible is met, Medicare pays 80% of the approved amount for services, and you are responsible for a 20% coinsurance per visit.
3. Supplemental Coverage: If you have a Medigap (Medicare Supplement) plan, it may cover some or all of your Part B coinsurance and deductibles.
4. Medicare Advantage: If you have a Part C plan, your coverage must be at least equal to Original Medicare, though your specific copayments and network requirements will vary by plan.

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