Understanding Medicare Coverage for Addiction Treatment
Does Medicare cover medication assisted treatment? Yes, Medicare does cover medication-assisted treatment (MAT) for substance use disorders, particularly opioid use disorder (OUD). Here’s what you need to know:
Medicare Part | MAT Coverage |
---|---|
Part A | Covers inpatient hospital MAT services, including methadone administered during hospitalization |
Part B | Covers outpatient MAT through Opioid Treatment Programs (OTPs) with NO copayment (Part B deductible applies) |
Part C (Medicare Advantage) | Must cover all OUD treatment services that Original Medicare covers, but may require in-network providers |
Part D | Covers many outpatient prescription drugs for OUD, including buprenorphine and naltrexone |
Medicare coverage for medication-assisted treatment expanded significantly following the SUPPORT Act of 2019, which enabled Medicare Part B to cover comprehensive services through OTPs. This includes FDA-approved medications (methadone, buprenorphine, naltrexone), counseling, therapy, drug testing, and periodic assessments.
For many people struggling with opioid addiction, accessing affordable treatment can be life-changing. Medicare’s coverage of MAT removes significant financial barriers to evidence-based care that combines medications with counseling and behavioral therapies.
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Does Medicare Cover Medication Assisted Treatment?
Yes — Medicare now pays for evidence-based medication-assisted treatment (MAT) for opioid use disorder through every part of the program. The SUPPORT Act of 2019 created a dedicated Opioid Treatment Program (OTP) benefit under Part B and filled most of the older coverage gaps.
Medicare Part | What It Covers for MAT |
---|---|
Part A | Inpatient hospital detox/rehab and methadone given during the stay |
Part B | Weekly bundled OTP services (medication, counseling, drug-testing) with no copay once the annual deductible is met |
Part D | Take-home prescriptions such as buprenorphine or naltrexone tablets |
Medicare Advantage | Must cover everything Original Medicare covers, but you may need in-network providers and prior-authorization |
By treating addiction like any other chronic condition, Medicare has removed many of the financial problems people once faced when trying to start recovery.
Which Medicare Parts Pay for MAT & Related Services
Part A handles brief inpatient stays for medical detox or acute psychiatric care.
Part B is the work-horse for ongoing recovery: it covers OTPs, office-based MAT visits, telehealth appointments, and long-acting injectable medications administered by a clinician.
Part C (Medicare Advantage) mirrors Parts A and B benefits but uses plan networks and rules.
Part D adds coverage for most take-home prescriptions (except methadone for OUD).
If you also have Medicaid, Medicare pays first and Medicaid can cover remaining costs.
Inpatient vs. Outpatient MAT
Inpatient care (Part A) usually lasts only long enough for safe withdrawal. Once stable, most people transition to outpatient services (Part B) like OTPs, Intensive Outpatient Programs, Partial Hospitalization, or telehealth.
Telehealth & Mobile Units
Medicare permanently expanded telehealth MAT coverage, allowing video (and in some cases audio-only) visits for intakes, counseling, and medication management. Mobile treatment units enrolled in Medicare are also covered — a vital option for rural Tennessee and Virginia residents.
What Medications & Therapies Are Covered
Medicare pays for every FDA-approved medication used to treat opioid use disorder:
- Methadone – in hospitals (Part A) or OTPs (Part B)
- Buprenorphine films/tablets such as Suboxone® – OTP under Part B or retail pharmacy under Part D
- Long-acting buprenorphine injections (Sublocade®, Brixadi®) – Part B when administered by a clinician
- Naltrexone tablets (Part D) and monthly injection Vivitrol® (Part B)
- Naloxone rescue kits – Part D or bundled with OTP care
Behavioral health is always included: counseling, group therapy, SBIRT screening, drug testing, and care coordination are all covered when medically necessary.
For details on injectable options, see the American Society of Addiction Medicine FAQ.
What Will I Pay? Deductibles, Copays & Ways to Save
- OTPs: $0 copay after the $240 (2024) Part B deductible.
- Other Part B services: 20 % coinsurance after the deductible.
- Part A hospital stay: $1,632 deductible per benefit period, then daily coinsurance after day 60.
- Part D prescriptions: costs vary by plan and drug tier.
Ways to save:
- Apply for a Medicare Savings Program and Extra Help for Part D.
- Receive as much care as possible through a Medicare-enrolled OTP.
- Compare Part D plans every year during Open Enrollment.
If Medicare denies a claim, start an appeal with a redetermination and escalate if needed. Free guidance is available at 1-800-MEDICARE or through your State Health Insurance Assistance Program.
Accessing Care: Finding a Medicare-Approved MAT Provider
- Use Medicare Care Compare or the SAMHSA OTP Directory to locate Medicare-enrolled clinics near Brentwood, Virginia Beach, and throughout Tennessee and Virginia.
- Telemedicine practices — including National Addiction Specialists — can treat you anywhere in those states.
- Always confirm the clinic is both SAMHSA-certified and Medicare-enrolled so you qualify for the $0 copay OTP bundle.
- Check your Part D formulary for buprenorphine or naltrexone coverage, and bring your Medicare cards to the first visit.
Make an Appointment to Treat Addiction
Please don’t hesitate. Make an appointment today.
Frequently Asked Questions about Medicare & MAT
How many counseling sessions does Medicare allow?
There is no fixed limit. Sessions are covered as long as your provider documents medical necessity.
Does Medicare cover MAT for alcohol use disorder?
Yes. Oral and injectable naltrexone, acamprosate, and disulfiram are covered under the same Parts B and D cost-sharing rules (there is no OTP bundle for alcohol treatment).
Are methadone take-home doses covered by Part D?
No. Take-home methadone for opioid use disorder is only covered under the Part B OTP benefit once you meet safety criteria. Part D never covers methadone for OUD.
Conclusion
Medicare’s modern benefits make starting recovery far easier than in the past. With $0-copay OTP bundles, full coverage of all FDA-approved medications, and broad telehealth options, the answer to “does Medicare cover medication assisted treatment?” is a clear yes.
National Addiction Specialists delivers this care entirely through telemedicine for residents of Tennessee and Virginia, providing confidential Suboxone treatment and counseling from the comfort of home.
Medically Reviewed By
Chad D. Elkin, MD, FASAM, ABIM, ABPM
Chad D. Elkin, MD, FASAM, ABIM, ABPM, is double board-certified in both Internal Medicine and Addiction Medicine and is a Fellow of the American Society of Addiction Medicine (ASAM). His professional interests focus on social determinants of health, addiction medicine, public education concerning the opioid epidemic, public speaking engagements, and addiction medicine legislative advocacy at the state and national level . He is heavily involved with ASAM with both national and state roles including activity on the Practice Management and Regulatory Affairs Committee (PMRAC), State Advocacy and Legislative Affairs Committee (SALC), and is the Legislative Chairman and President-elect for the Tennessee chapter of ASAM.
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