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Medicare Now Covers Opioid Addiction Treatment for Qualified Beneficiaries

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.

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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