Opioid use disorder treatment services

Medicare Part B (Medical Insurance)

 covers opioid use disorder treatment services in opioid treatment programs.

Note:
Medicare drug coverage (Part D) also covers drugs like buprenorphine (to treat opioid use disorders) and methadone (when prescribed for pain).

Medicare Part A (Hospital Insurance) covers methadone when it’s used to treat an opioid use disorder as a hospital inpatient.
 

Your costs in Original Medicare

You won't have to pay any copayments for these services if you get them from an opioid treatment program provider who's enrolled in Medicare and meets other requirements. However, the Part B

deductible [glossary]

 still applies for supplies and medications you get through an opioid treatment program provider.

Medicare pays doctors and other providers for office-based opioid use disorder treatment, including management, care coordination, psychotherapy and counseling activities.   

What it is

These services, which help people recover from opioid use disorder, include:

  • Medication (like methadone, buprenorphine, naltrexone, and naloxone)
  • Substance use counseling
  • Individual and group therapy
  • Drug testing
  • Intake activities
  • Periodic assessments
  • Opioid antagonist medications (like naloxone) approved for the emergency treatment of known or suspected opioid overdose
  • Overdose education you get along with opioid antagonist medication

Medicare covers counseling, therapy, and periodic assessments both in person and virtually (using video technology like your computer, or audio-only technology like your phone). Medicare also covers services given through opioid treatment program mobile units.

Things to know

Talk to your doctor or other health care provider to find out where to go for these services. You can also visit Medicare.gov/talk-to-someone and select "Find treatment near you" on the “Find treatment for opioid misuse” card.

Medicare Advantage Plans must also cover opioid treatment program services. If you’re in a Medicare Advantage Plan, your current opioid treatment program must be Medicare-enrolled to make sure your treatment stays uninterrupted. If not, you may have to switch to a Medicare-enrolled opioid treatment program. Since Medicare Advantage Plans can apply copayments to opioid treatment program services, you should check with your plan to see if you have to pay a copayment.