Methadone, also known as Dolophine and Methadose, is a synthetic opioid agonist. This means it is used to treat chronic pain and opioid dependencies and/or addictions.
It is the most well-known and oldest opioid treatment. If you or a loved one requires this type of treatment, a common question you may have is, “Does Medicare cover Methadone Treatment?”
In this article, we answer the question in clear, plain English. You will also find the average cost of treatment for those who have to pay out of pocket.
Does Medicare Cover Methadone Treatment?
The short answer is yes; Medicare will cover the cost of methadone treatment. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your methadone treatment. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Methadone Treatment
Original Medicare (Medicare Part A and Part B) provides coverage for methadone treatment and other drug rehab options.
However, this plan will only cover methadone treatment and rehabilitation when it is medically necessary. Your healthcare provider must first order the treatment for Original Medicare to provide coverage.
When is Treatment Covered by Part A?
Coverage for methadone treatment is provided by Medicare Part A if your methadone treatment takes place in an inpatient setting.
Medicare Part A also provides coverage for the following related services:
- Inpatient hospitalization
- Inpatient drug rehabilitation services
- The care given by the nurses and doctors
- Medications that are necessary to treat your drug addiction and substance abuse while you are an inpatient, such as methadone
Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will be responsible for paying a copayment.
When is Treatment Covered by Part B?
On the other hand, coverage for methadone treatment is provided by Medicare Part B. Medicare Part B also provides coverage for the following services for drug and alcohol rehabilitation:
- Mental health counseling
- Alcohol misuse screenings
- Individual or group therapy
- Certain prescription drugs
- Intensive outpatient drug rehabilitation
- Outpatient hospital services
- Partial hospitalization
Medicare Part B may also provide coverage for Screening, Brief Intervention, and Referral to Treatment (SBIRT).
Once approved, Medicare Part B covers 80 percent of methadone treatment costs. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Methadone Treatment
Medicare Advantage plans (Medicare Part C) also provide coverage for methadone treatment and other drug and alcohol rehab.
This is because these plans must cover everything Original Medicare covers. But these Advantage plans will also provide coverage for some things Original Medicare does not cover. What is covered will depend on your plan.
How Much Does Methadone Treatment Costs
How much any type of addiction treatment costs varies according to several factors, including the location, duration, and type of treatment. The cost of a single dose of methadone averages around $84.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare cover skin tag removal?