Does Medicare Cover Methadone?

Methadone is a drug used by healthcare professionals to treat people who are experiencing extreme pain. Today, healthcare professionals also use it as a part of a treatment program to treat addiction to both heroin and other narcotic painkillers.

If you or a loved one need this treatment, a common question you likely have is, “Does Medicare Cover Methadone?”

In this article, we will answer this question in plain English. You will also find the average costs of Methadone and other helpful info.

The short answer is yes. Medicare will cover the cost of Methadone. 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. Below we look at what these are so you know what to expect.

Original Medicare Coverage of Methadone

Original Medicare provides coverage for Methadone as part of Medicare Part B only. However, Medicare will only provide coverage if it’s used for opioid treatment programs, or OTPs.

These OTPs are the only locations where people addicted to opioids can receive methadone as part of their treatment.

What Does Medicare Cover through the OTP Benefit?

The OTP benefit compels Medicare to cover the following:

Opioid treatment medications, like methadone, that are approved by the FDA
Counseling for substance use
Testing for toxicology
Individual therapy
Group therapy
Assessments periodically
Intake activities
Dispensing and administration of the treatment medications

How Much Does Methadone Cost?

How much methadone costs depends on a number of factors such as do you get it in an inpatient or outpatient setting. A single dose of methadone averages around $80 or so. Though typically methodone treatments last for at least one year so the costs can add up.

The $80 per dose average, however, makes methadone less expensive than drug rehab alternatives such as buprenorphine and naltrexone which can range from $250 – $400.

What Does Methadone Do?

Methadone alters the way your brain and nervous system respond to pain, allowing you to experience temporary relief. Its effects are more gradual than those of other powerful analgesics such as morphine, for example.

If you’re suffering from severe pain as a result of an injury, surgery, or long-term illness, your doctor may recommend methadone.

It also has the added benefit of preventing the high caused by drugs such as codeine, heroin, hydrocodone, morphine, and oxycodone. It can provide a similar sensation while also preventing withdrawal symptoms and cravings from occurring. This is also referred to as replacement therapy.

In most cases, it is only a portion of your overall treatment plan. It isn’t a magic solution for addiction problems.

The Risks of Taking Methadone

While Methadone is usually used for treatment, it also comes with risks. You shouldn’t take Methadone if you have the following:

A heart rhythm disorder
A history of head injury, brain tumor, or seizures
An electrolyte imbalance
Heart disease
Trouble breathing
Lung disease
Thyroid problems
Gallbladder problems
Problems in the pancreas
If you are taking sedatives
If you have problems with urinating

Where to Find Medical Care and Admittance of Methadone

Find out where these services are available by speaking with your doctor or other health-care provider. You can also search for an opioid treatment program near you by visiting Medicare.gov/contacts and selecting “Opioid Treatment Program Services.”

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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.