Opioid Use Disorder treatment services
Medicare covers Opioid Use Disorder (OUD) treatment services for people with Medicare when you get them from a doctor or other health care provider, or through a more comprehensive Opioid Treatment Program (OTP).
Your costs in Original Medicare
You won’t have to pay any copayments for Opioid Use Disorder (OUD) treatments if you get them from an Opioid Treatment Program (OTP) that’s enrolled in Medicare and meets other requirements. If you get supplies and medications through an OTP, the Part B deductible still applies.
If you get these services from a doctor or health care provider, the usual copayments and Part B deductible still apply.
What it is
There are multiple treatment options available:
- Medication-assisted treatment medications approved to treat OUD, like methadone, buprenorphine, naltrexone, and naloxone:
- Medicare Part A (Hospital Insurance) covers methadone when it’s used to treat OUD as a hospital inpatient.
- Medicare Part B (Medical Insurance) covers methadone, buprenorphine, and naltrexone when you get it through an OTP.
- Medicare drug coverage (Part D) may also cover drugs like buprenorphine, naloxone, and naltrexone. Contact your plan for more information.
- OUD treatment by a doctor or other health care provider:
- Overall care management with your care team
- Care coordination
- Individual and group psychotherapy
- Substance use counseling
- Additional counseling
- Opioid Treatment Programs:
- Medication-assisted treatments like methadone, buprenorphine, naltrexone, and naloxone
- Drug testing
- Substance use counseling
- Individual and group psychotherapy
- 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
- Intensive outpatient services for the treatment of OUD
Note: Hospital outpatient departments, community mental health centers, rural health clinics, and federally qualified health centers offer intensive outpatient services for the treatment of a mental health condition and/or substance use disorder, including OUD. - Medication management (generally, oversees how you take medications that are a
part of your recovery process)
Things to know
Talk to your doctor or other health care provider to find out where to go for these services. You can also search for providers at the top of this page.
Medicare Advantage Plans must cover all OUD treatments covered by Medicare, but Medicare Advantage Plans may limit their coverage to suppliers in their plan’s network. Some OUD treatment services are only covered if the supplier is enrolled in Medicare. If your supplier isn’t enrolled in Medicare, you may have to switch to Medicare-enrolled suppliers. You may also have to pay a copayment. Contact your Medicare Advantage Plan for more information.