News
Medicare Now Covers Opioid Addiction Treatment for Qualified Beneficiaries
- February 5, 2021
Published Jan. 27, 2020
Medicare is joining the fight against the opioid epidemic.
Under a new rule that took effect in January 2020, Medicare will now be offering coverage for select services at opioid treatment programs (OTPs) or methadone clinics for qualified beneficiaries.
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How much does Medicare pay for opioid addiction treatment?
The coverage will be included under Medicare Part B. Part B is optional for all beneficiaries and comes with a standard premium of $144.60 per month in 2020, though some beneficiaries may pay a higher premium based on their income.
Beneficiaries will not pay any coinsurance for the OTP benefits after they have reached the annual Part B deductible of $198 in 2020.
Does Medicare cover methadone?
OTPs are the only locations where people addicted to opioids can receive methadone as part of their treatment. Under the new coverage rules, Medicare Part B may cover:
- Opioid treatment medications that are approved by the U.S. Food and Drug Administration (FDA) such as methadone
- The administration of the treatment medications (if needed)
- Counseling for substance use
- Group and individual therapy
- Toxicology testing
- Intake activities
- Periodic assessments
Medicaid already provided coverage of methadone treatment for dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid). Under the new rule, Medicare will act as the primary payer for OTP services.
The new rule comes as a result of the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Under the legislation, Congress expanded access to opioid use disorder treatment services and authorized the creation of Medicare’s OTP benefit.
Medicare and drug addiction treatment
Medicare provides some coverage for drug and alcohol rehabilitation treatment, as long as the services are determined to be medically necessary, a plan of care is established by the provider and the services are received at a Medicare-approved facility or from a Medicare-approved provider.
Medicare Part A provides coverage for inpatient treatment received at a hospital or rehab center. Part B provides coverage for outpatient treatment from a clinic or hospital outpatient center.
Some Medicare Part D prescription drug plans may help pay for drugs that are considered medically necessary to treat substance use disorders.
Medicare Advantage (Medicare Part C) plans, provides coverage for everything covered by Medicare Part A and Part B, and some may also provide coverage for prescription drugs used to treat substance use.
A licensed insurance agent can help you compare Medicare Advantage plans and Medicare Part D prescription drugs plans in your area that may help cover prescription drugs used to treat addiction. You can also compare plans online, with no obligation to enroll.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
