Does Medicare Cover Opioid Treatment Programs?

Medicare Part B covers opioid use disorder (OUD) treatment received at opioid treatment programs. Opioid treatment programs (OTPs), which are also known as methadone clinics, are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide methadone as part of medication-assisted treatment. OTPs are the only place where an individual can receive methadone to treat opioid use disorder.

In order to receive Medicare coverage for OTP services, the OTP must:

  • Be certified by SAMHSA
  • Enroll in the Medicare program

Once an OTP is enrolled in Medicare, it can bill Medicare for the services provided to you. Therefore, if you want to get Medicare-covered OTP services you should contact the OTP to make sure it accepts Medicare. If the OTP is not enrolled in Medicare, you are responsible for the cost of the care.

If you have both Medicare and Medicaid and were previously receiving Medicaid-covered OTP services, Medicaid should continue to pay primary for treatment until the OTP is enrolled in Medicare. At this time, once you meet your deductible, you will not owe any cost-sharing (coinsurance or copayment) for OTP.

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