Does Medicare Cover Treatments for Opioid Addiction?

In October 2019, Congress passed the SUPPORT for Patients and Communities Act. In addition to expanding resources for patients with opioid addiction, the act enabled Medicare Part B coverage for opioid addiction treatment. With the signing of this act, providers like Health Care Resource Centers (HCRC) and its affiliates can accept Medicare insurance.

How Does Medicare Cover Opioid Addiction Treatment?

The Medicare national health insurance program covers medical services for specific populations. Medicare includes four parts based on the type of services covered. Under the SUPPORT for Patients and Communities Act, Medicare Part B, the part dedicated to outpatient care, can cover opioid addiction treatment.

Your coverage for opioid addiction treatment under Medicare will depend on the type of Medicare plan you have. If you already participate in opioid addiction treatment, you may have to switch to a provider that takes Medicare. Patients who have Medicare Advantage Plans might also receive copayment charges. Original Medicare plan participants usually have to pay nothing once their deductible applies.

What Opioid Addiction Treatments Can Medicare Cover?

Medicare can now cover opioid treatment services that previously did not receive coverage, including:

Medication-Assisted Treatment (MAT)

The field of addiction medicine considers medication-assisted treatment (MAT) a best practice for addressing opioid addiction. During MAT, a patient takes medication to relieve their withdrawal symptoms. With the passage of the SUPPORT for Patients and Communities Act, Medicare now covers these MAT medicines:

• Methadone: Methadone targets the opioid receptors in the brain to reduce cravings and withdrawal symptoms. It involves daily treatment visits during the beginning of a methadone-based MAT program.
• Buprenorphine: Buprenorphine works similarly to methadone, but it has a “ceiling effect” that makes it safer to take at home. Many buprenorphine drugs also contain the opioid-blocking medicine naloxone.

Individual and Group Therapy/Counseling

Research shows that combining MAT with counseling provides enhanced results compared to either treatment by itself. Patients can participate in one or both of these types of therapy:

• Individual: During individual counseling sessions, the patient and therapist set recovery goals and work towards achieving them.
• Group: Group therapy allows patients to support one another and find solidarity in recovery.

Drug Testing

Many MAT programs perform regular drug testing to comply with federal regulations and protect patients. These screenings help medical professionals discover relapse symptoms or co-occurring substance use.

How Does Medicaid Factor Into These Changes?

Before the passage of the SUPPORT for Patients and Communities Act, some states provided opioid addiction treatment coverage through Medicaid. If you live in one of these states, treatment providers now consider Medicaid the secondary payer. Most Medicaid patients will need to pay a small copayment for their covered MAT drugs.

Do All Opioid Addiction Treatment Programs Take Medicare?

An opioid addiction treatment program must meet specific criteria to accept Medicare from patients. HCRC and our affiliates across the country have the approval to take Medicare coverage. Additional providers in the BayMark network include MedMark Treatment Centers and BAART Programs. These clinics provide treatment across the United States, making Medicare-covered opioid addiction care available to numerous patients.

Learn More About Medicare and Opioid Addiction Treatment

For more information about Medicare coverage at HCRC and our affiliates, contact our staff online or call 866-758-7769.

Medically Reviewed By:

Health Care Resource Centers Clinical Team

Health Care Resource Centers Clinical Team

The Clinical Team at Health Care Resource Centers is our team of physicians and medical directors within the organization. HCRC is a CARF accredited organization and has been providing addiction treatment services for over 32 years in the New England area.