Does Medicare Cover Opioid Use Disorder Treatment?

Medicare covers:

• Medications to help stop or reduce opioid use, including methadone, buprenorphine, and naltrexone.
• Medications to rapidly reverse the effects of an opioid overdose, including nalmefene and naloxone.
• 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 communication.

There are multiple treatment options available:

• Medications to treat Opioid Use Disorder:
• Medicare Part A (Hospital Insurance) covers methadone, buprenorphine, and naltrexone when you get it as an inpatient at the hospital.
• Medicare Part B (Medical Insurance) covers methadone, buprenorphine, and naltrexone when you get them in a doctor’s office or through an Opioid Treatment Program. Part B also covers nalmefene and naloxone to rapidly reverse the effects of an opioid overdose.
• Medicare drug coverage (Part D) may cover buprenorphine and naltrexone, and drugs to rapidly reverse the effects of an opioid overdose (like nalmefene and naloxone). 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
• In some cases, medications for Opioid Use Disorder (like buprenorphine and naltrexone)

You may be able to start buprenorphine treatment without an in-person exam if your health care provider can adequately evaluate you using audio and video, or audio-only communication. However, you may need to do an in-person exam if you need other medications.

• Opioid Treatment Programs (including mobile opioid treatment units):
• Medications for Opioid Use Disorder (like methadone, buprenorphine, and naltrexone)
• Medications to reverse the effects of an opioid overdose (like naloxone and nalmefene) and overdose education
• 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
• Intensive outpatient services

Program must be enrolled in 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. The Part B deductible applies for these services, including any supplies and medications you might get as part of your treatment.
• If you get these services from a doctor or other health care provider, you'll pay copayments and 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.

People with Medicare who've been diagnosed with Opioid Use Disorder can get treatment services for as long as it's reasonable and necessary.