Opioid Use Disorder treatment services
Your costs in Original Medicare
- If you get these services from an Opioid Treatment Program that’s enrolled in Medicare and meets other requirements, you won't have to pay any copayments . However, if you get supplies and medications through an Opioid Treatment Program, the Part B deductible still applies.
- If you get these services from a doctor or other health care provider, you pay the usual copayments for the services after you meet the Part B deductible.
- If you have both Medicare and Medicaid, you pay nothing for the services that you get through your state Medicaid program.
What it is
People with Medicare who've been diagnosed with Opioid Use Disorder can get treatment services for as long as they're needed. There are multiple treatment options available:
- Medications to treat Opioid Use Disorder:
- Medicare Part A (Hospital Insurance) covers methadone when you get it as an inpatient at the hospital.
- Medicare Part B (Medical Insurance) covers methadone, buprenorphine, naltrexone, and nalmefene hydrochloride when you get it through an Opioid Treatment Program.
- Medicare drug coverage (Part D) may also cover drugs like buprenorphine, naloxone, and naltrexone. Contact your plan for more information.
- Opioid Use Disorder treatment by a doctor or other health care provider:
- Overall care management with your care team including coordination of care
- Individual and group therapy
- Substance use and other additional counseling
- Opioid Treatment Programs (including mobile opioid treatment units):
- Medications (like methadone, buprenorphine, naltrexone, naloxone, and nalmefene hydrochloride)
- Preparation and help taking medications that are part of your recovery process
- Drug testing
- Substance use counseling
- Individual and group therapy
- Intake activities and other periodic assessments
- Coordinated care and/or referral services
- Peer recovery support services
- Overdose education you get along with opioid antagonist medication (like naloxone) approved for emergency treatment of known or suspected opioid overdose
- Intensive outpatient services
Things to know
- Talk to your provider to find out where to go for these services. You can also search for providers at the top of this page.
- Medicare covers counseling, therapy, and periodic assessments both in person and, in certain circumstances, by virtual delivery (using audio and video communication technology, like your phone or a computer). Medicare may also cover periodic assessments that use audio-only technology.
- Medicare covers social determinants of health (SDOH) risk assessments as part of intake activities and periodic assessments related to an Opioid Use Disorder diagnosis or treatment.
- You may be able to start methadone and buprenorphine treatment without an in-person exam if your Opioid Treatment Program provider can adequately evaluate you using audio and video communication technology.
- Medicare Advantage Plans must cover all Opioid Treatment Program services covered by Medicare, but may require that you go to an in-network Opioid Treatment Program. If you join a Medicare Advantage Plan when you’re already getting treatment, your Opioid Treatment Program must participate with your plan and be Medicare-enrolled to make sure your treatment is covered and stays uninterrupted. If not, you may have to switch to an Opioid Treatment Program that participates with your plan. Since Medicare Advantage Plans can apply copayments to Opioid Treatment Program services, check with your plan to find out if you have to pay a copayment.