Medicare and Opioid Treatment—A Match Made in Healthcare Heaven?

Understanding Medicare’s Opioid Treatment Coverage

Medicare opioid treatment services are comprehensive and cover several key medications and therapies. Here’s what you need to know:

Since January 2020, Medicare has dramatically expanded access to opioid treatment programs (OTPs), with acceptance rates jumping from 21% to over 80% of facilities nationwide. This means more Medicare beneficiaries can now access life-saving treatments without facing copayments when using enrolled providers.

The opioid crisis continues to impact Americans of all ages, with nearly 82,000 opioid-related overdose deaths occurring in 2021 alone. For Medicare beneficiaries struggling with opioid use disorder (OUD), understanding coverage options is crucial for accessing effective treatment.

Medicare now covers a full spectrum of OUD treatments including:

• Medication-assisted treatment (methadone, buprenorphine, naltrexone)
• Individual and group therapy
• Substance use counseling
• Toxicology testing
• Periodic assessments
• Overdose education and naloxone
• Mobile treatment units and telehealth services

I’m Dr. Chad Elkin, a board-certified addiction medicine physician and founder of National Addiction Specialists, with extensive experience helping patients steer Medicare opioid treatment options as President of the Tennessee Society of Addiction Medicine and through my work on multiple national committees focused on improving addiction care access.

Important Medicare opioid treatment terms:

• suboxone side effects weight loss
• suboxone treatment
• suboxone withdrawal

Medicare Opioid Treatment Coverage 101: Parts A, B, D & MA

Medicare’s coverage for opioid treatment can feel like navigating a maze. Let’s break it down into something that actually makes sense, so you can understand exactly what benefits you have.

Part A—Inpatient Safety Net for Severe Cases

Think of Medicare Part A as your safety net during the most difficult moments of opioid use disorder. When someone needs around-the-clock medical care, Part A steps in to cover:

• Hospital stays for medically supervised withdrawal (what many call “detox”)
• Methadone treatment while you’re in the hospital
• Medical stabilization during crisis situations
• Residential treatment when it’s medically necessary

These services typically come into play when someone is experiencing severe withdrawal symptoms that require constant medical supervision. While incredibly important during these critical periods, Part A is just one piece of a complete recovery journey.

Part B—The Heart of Medicare Opioid Treatment

Part B is where Medicare opioid treatment really shines. Since January 2020, Medicare Part B has covered comprehensive services at opioid treatment programs (OTPs) that simply weren’t available to Medicare beneficiaries before.

“The Part B coverage expansion has been life-changing for our Medicare patients,” explains Dr. Elkin. “Before 2020, Medicare beneficiaries couldn’t access methadone maintenance therapy outside of a hospital. Now they can receive this proven treatment in outpatient settings, which has dramatically improved access to care.”

Part B now covers:

Medication services: Methadone maintenance (the game-changer), buprenorphine administration, and naltrexone treatment

Support services: Individual and group therapy, substance use counseling, regular drug testing, intake assessments, and periodic check-ins

The best part? There are no copayments for OTP services when you visit Medicare-enrolled providers. The Part B deductible ($240 in 2024) still applies, but eliminating copays removes a huge financial barrier to consistent treatment.

Part B also covers counseling via telehealth, including audio-only options when video isn’t available—a real breakthrough for rural patients or those without reliable internet.

Part D—Your Pharmacy Benefit for Take-Home Meds

Medicare Part D handles your outpatient prescription medications related to opioid treatment:

Buprenorphine/naloxone (Suboxone) prescriptions that you fill at your local pharmacy

Naltrexone tablets for ongoing maintenance

Naloxone (Narcan) to prevent overdose

Methadone when prescribed for pain (but not for opioid use disorder treatment)

Always check your specific Part D plan’s formulary to confirm coverage details. Your costs will vary based on your plan and which coverage phase you’re in (deductible, initial coverage, coverage gap, or catastrophic coverage).

Medicare Advantage: Same Rules, More Networks

If you have a Medicare Advantage (Part C) plan, you’ll get the same opioid treatment coverage as Original Medicare, but with some important differences:

Your plan may require you to use in-network providers for treatment. This network restriction can sometimes limit your options, but it can also mean more coordinated care.

You might face different copayment structures than Original Medicare beneficiaries.

Some services may require prior authorization before they’re covered.

Prescription drug formularies might differ from standard Part D plans.

For folks who have both Medicare and Medicaid (dual-eligible beneficiaries), Medicare pays first for OTP services, with Medicaid potentially covering additional costs or services that Medicare doesn’t.

“Understanding your specific plan details is crucial,” Dr. Elkin advises. “A quick call to your Medicare Advantage plan can save you from unexpected costs and help you find the right providers within your network.”

For more detailed information about Medicare’s coverage of opioid treatment programs, you can review the CMS Medicare Benefit Policy Manual Chapter 17.

Looking for more information about insurance coverage for addiction treatment? Visit our Insurance and Pricing page for detailed guidance.

From Policy to Practice: 2020 OTP Expansion, Telehealth & Enrollment

January 1, 2020 marked a turning point for Medicare opioid treatment in America. On that day, the SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act) provisions finally took effect, creating a brand-new Medicare benefit category specifically for opioid treatment programs.

How the 2020 Rule Opened up Methadone for Seniors

Before this landmark change, older adults on Medicare faced a heartbreaking reality: methadone maintenance—one of the most effective treatments for opioid addiction—simply wasn’t covered outside of hospitals. Many seniors and disabled individuals had to make impossible choices between paying out-of-pocket or going without this life-saving medication.

The numbers tell a remarkable story of change:

“I’ve watched patients in their 60s and 70s who struggled for years finally get the help they needed,” shares Dr. Elkin. “Before 2020, they were essentially locked out of methadone treatment unless they could somehow afford to pay cash. The change has been nothing short of life-saving.”

Medicare acceptance among OTPs skyrocketed from just 21.3% in 2018 to an impressive 80.8% by 2021. Even more telling, the percentage of U.S. counties with at least one Medicare-accepting OTP more than tripled, growing from a meager 5.0% to 17.9% in that same period. By 2021, one-third of Medicare-only beneficiaries lived in counties that newly had access to at least one Medicare-accepting OTP.

What’s particularly encouraging is how this policy helped address historical inequities. Counties with higher percentages of non-White residents saw an additional average increase of 0.86 Medicare-accepting OTPs compared to counties with lower non-White populations—suggesting the expansion is helping bridge long-standing gaps in treatment access.

Telehealth & Mobile Units—Care Without Walls

The Medicare OTP benefit didn’t just expand who could get treatment—it revolutionized how that treatment could be delivered.

Telehealth services have become a cornerstone of modern Medicare opioid treatment. Medicare now covers counseling, therapy sessions, and regular assessments delivered virtually, with specific billing codes that make it feasible for providers. Video sessions use modifier 95, while audio-only appointments (when video isn’t an option) use modifier 93 or FQ.

During COVID-19, these options expanded dramatically, and many of these flexibilities have been extended through 2024 and beyond. For example, providers can conduct periodic patient assessments via phone call when video isn’t possible—a small change that makes a world of difference for seniors with limited technology access or those in rural areas.

Mobile treatment units represent another innovative approach. These traveling clinics can bring medication administration, counseling, and other OTP services directly to underserved communities or individuals facing transportation barriers. Medicare covers these services using the same billing codes as traditional clinics, removing a significant obstacle to consistent treatment.

At National Addiction Specialists, we’ve acceptd telehealth technology to make Medicare opioid treatment more accessible throughout Tennessee and Virginia. Our platform allows patients to connect with providers from the privacy of their homes, eliminating transportation problems and reducing the stigma that keeps many from seeking help.

Enrolling an OTP in Medicare

For facilities wanting to provide Medicare-covered OTP services, the path involves several important steps:

First, the facility must secure SAMHSA certification, demonstrating it meets federal standards for opioid treatment. This must be paired with independent accreditation from a SAMHSA-approved accrediting body—essentially a seal of quality approval.

Next comes enrollment in Medicare through the Provider Enrollment, Chain, and Ownership System (PECOS), along with maintaining strict compliance with DEA regulations for handling controlled substances.

To qualify for Medicare reimbursement, OTPs must offer a comprehensive suite of services including all FDA-approved medications for opioid use disorder, both individual and group counseling, regular toxicology testing, intake activities, periodic assessments, and coordinated care.

While navigating this process can be challenging, the dramatic increase in Medicare-accepting OTPs since 2020 shows that many facilities have successfully made the transition, expanding life-saving options for Medicare beneficiaries across the country.

Want to learn more about how telehealth can help with opioid treatment? Visit our Telehealth Opioid Treatment page for more information.

Dollars & Data: Billing, Costs, and Provider Requirements

When it comes to Medicare opioid treatment, the financial side might seem complicated at first. But don’t worry—I’ll break down how the money works in a way that makes sense, whether you’re a patient wondering about costs or a provider figuring out billing.

Decoding the G-Codes

Medicare uses what’s called a “bundled payment system” for opioid treatment programs (OTPs). Think of it like ordering a meal deal instead of paying for each item separately—one price covers everything you need for the week.

These bundles are identified by special codes called G-codes:

• G2067 covers a week of methadone treatment
• G2068 is for oral buprenorphine (like Suboxone tablets)
• G2069 covers injectable buprenorphine
• G2070 is for oral naltrexone
• G2071 covers injectable naltrexone
• G2072 is for other medications not specified above
• G2073 covers treatment without medication

“The beauty of this bundled approach,” says Dr. Elkin, “is that it covers not just the medication, but also the counseling, therapy, and drug testing a person needs each week. It’s comprehensive care in one package.”

There are also add-on codes for extra services when needed. For example, G2076 covers intake activities when you’re first starting treatment, and G2215 covers naloxone kits for overdose prevention.

In 2024, Medicare recognized that some people need more intensive help by adding a new payment adjustment (G0137) for Intensive Outpatient Program services at OTPs—a step in the right direction for those requiring extra support.

What Beneficiaries Pay (or Don’t)

Here’s some great news if you’re on Medicare: you’ll pay zero copayments for OTP services when you go to a Medicare-enrolled provider. This is one of the most patient-friendly aspects of the program.

You’ll still need to meet your Part B deductible ($240 in 2024) for supplies and medications, but after that, Medicare covers 100% of your OTP services. This zero-copayment policy is pretty rare in Medicare and shows how important the government considers opioid treatment to be.

“Even small out-of-pocket costs can be a deal-breaker for people seeking addiction treatment,” Dr. Elkin explains. “By eliminating copayments, Medicare has removed a major roadblock to recovery for many seniors and disabled individuals.”

If you have a Medicare Advantage plan instead of Original Medicare, you might have some copayments depending on your specific plan—but remember, these plans must provide at least the same coverage as Original Medicare.

Provider Economics & Quality Incentives

Not all treatment facilities are created equal. Research shows some interesting differences between for-profit and nonprofit OTPs:

Only about one-third (31.7%) of OTPs offer comprehensive mental health assessments. The number drops even lower—to just 14.7%—among for-profit facilities. This matters because most patients receiving methadone (about 62% or 191,625 people in 2020) get their treatment at for-profit OTPs.

To encourage better, more comprehensive care, Medicare has introduced the Value in Treatment (ViT) Demonstration Program running from April 2021 through December 2024. This program offers participating OTPs extra payments for providing high-quality care, including monthly care management fees and performance-based incentives.

“While medication is essential in treating opioid addiction,” says Dr. Elkin, “we know that addressing the whole person—including mental health and social needs—leads to better long-term recovery. Programs like ViT help make that comprehensive care financially viable for providers.”

At National Addiction Specialists, we believe in this whole-person approach. We work within the Medicare system to provide comprehensive Medicare opioid treatment that addresses not just the addiction itself, but the full spectrum of a person’s needs on their recovery journey.

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Access, Equity & Quality: Who Still Struggles and How to Fix It

The road to recovery shouldn’t depend on your zip code, but unfortunately, that’s still the reality for many Medicare beneficiaries seeking opioid treatment. While we’ve made impressive strides, some significant problems remain that prevent people from getting the help they need.

Medicare Opioid Treatment Disparities—By the Numbers

The good news? By 2021, one-third of Medicare-only beneficiaries found themselves living in counties that newly gained access to at least one Medicare-accepting OTP. That’s real progress worth celebrating.

But flip that statistic around, and you’ll see the challenge we still face: 35% of Medicare beneficiaries still live in counties without any Medicare-accepting OTPs. For these individuals, accessing life-saving treatment often means lengthy travel, which can be particularly difficult for older adults or those with mobility issues.

When we look at treatment continuity, the numbers tell an even more concerning story. Only about 40% of Medicare enrollees who started buprenorphine treatment continued it long-term. Even more troubling, just one-third received any behavioral therapy alongside their medication. Yet the data clearly shows that those who stick with treatment have better outcomes—they’re less likely to die and more likely to achieve lasting recovery.

“These aren’t just statistics,” says Dr. Elkin. “Each number represents a real person struggling with opioid use disorder who deserves access to comprehensive care, regardless of where they live or their personal circumstances.”

The disparities become even more pronounced when we look at geography:

Rural counties have significantly fewer OTPs compared to urban areas, creating treatment deserts where help is simply out of reach. Some states have alarmingly limited OTP availability, forcing patients to cross state lines for care. And transportation barriers—especially for older adults or those with disabilities—can make even relatively short distances impossible.

For a deeper dive into these disparities, you can review the research published in Health Affairs on Medicare-accepting OTPs and treatment access.

Ancillary Services: More Than Medication

True recovery isn’t just about the medication—it’s about healing the whole person. That’s why comprehensive Medicare opioid treatment should include a range of supportive services that address the full spectrum of a person’s needs.

These vital ancillary services include:

• Mental health assessments and treatment for co-occurring conditions
• HIV/AIDS and hepatitis C education and testing to address related health concerns
• Employment assistance and vocational rehabilitation to rebuild financial stability
• Housing support to create the stable foundation needed for recovery

Unfortunately, access to these services varies dramatically. In 2021, less than a third of OTPs (just 31.7%) offered comprehensive mental health assessments. For-profit facilities were significantly less likely to provide these supportive services compared to their nonprofit counterparts.

“At National Addiction Specialists, we believe in treating the whole person,” Dr. Elkin emphasizes. “Medication alone rarely leads to lasting recovery. People need support addressing the psychological, social, and physical aspects of addiction.”

That’s why our approach includes comprehensive mental health evaluations, coordination with other healthcare providers, counseling alongside medication, and education on preventing overdose. We recognize that recovery is a journey that touches every aspect of a person’s life.

Policy Levers on the Horizon

The good news is that policymakers are increasingly recognizing these gaps and working to address them. Several promising changes are coming that could significantly improve Medicare opioid treatment access and quality:

Starting in 2025, Medicare will integrate Social Determinants of Health (SDOH) assessments into both intake and periodic evaluations at OTPs. This represents a huge step forward in recognizing how factors like housing instability, unemployment, and lack of social support can derail recovery efforts.

Medicare has also permanently authorized audio-only telehealth for periodic assessments when video isn’t available. This simple change makes a world of difference for rural patients or those with limited technology access.

New add-on billing codes coming in 2025 will encourage OTPs to provide coordinated care, patient navigation, peer support, and emergency overdose treatment. By creating financial incentives for these services, Medicare is helping ensure more comprehensive care.

The Office of Inspector General has recommended several quality improvements, including better education for providers about supportive services, reviewing bundled payment structures, and improving connections between emergency departments and ongoing care.

“These policy changes reflect growing recognition that effective opioid treatment requires a comprehensive, patient-centered approach,” notes Dr. Elkin. “By addressing social factors, improving telehealth access, and incentivizing supportive services, Medicare is moving in the right direction—though we still have work to do.”

If you or someone you love is struggling with opioid use disorder, don’t wait for perfect policy solutions. Help is available now. At National Addiction Specialists, we work within the current system to provide the most comprehensive care possible, meeting you where you are on your journey to recovery.

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Frequently Asked Questions about Medicare Opioid Treatment

Does Medicare really pay for methadone?

Yes, Medicare does cover methadone for opioid use disorder, but it’s important to understand exactly where and how you can access this treatment:

When you’re struggling with opioid addiction, methadone can be a lifeline—and Medicare now makes this treatment more accessible than ever before. Coverage works differently depending on which part of Medicare you’re using:

Medicare Part A covers methadone during inpatient hospital stays when you need that higher level of care and supervision.

Medicare Part B is where the real breakthrough happened in 2020—it now covers methadone when you receive it at an enrolled opioid treatment program (OTP). This change has been nothing short of transformative for older adults and people with disabilities.

Medicare Part D will cover methadone when it’s prescribed for pain management, but not for addiction treatment—that’s where Part B comes in.

“This was a watershed moment in addiction treatment for older adults and disabled individuals,” says Dr. Elkin. “Methadone has decades of evidence supporting its effectiveness, and now Medicare beneficiaries can finally access this life-saving medication.”

Before 2020, Medicare beneficiaries faced a frustrating gap—they couldn’t get coverage for outpatient methadone maintenance therapy, putting one of the most effective treatments out of reach unless they could pay entirely out-of-pocket.

Will I owe anything at an OTP?

Here’s some good news that surprises many patients: Medicare has eliminated copayments for OTP services. This means when you visit a Medicare-enrolled opioid treatment program:

You’ll face no copayments for your treatment services—a policy specifically designed to remove financial barriers to getting the help you need.

The only potential out-of-pocket cost is meeting your Medicare Part B deductible ($240 in 2024), which applies to supplies and medications. But once you’ve met that deductible, Medicare covers 100% of your OTP services.

If you have a Medicare Advantage plan, your experience might be slightly different:

These plans must cover at least what Original Medicare covers, but they might require you to use providers in their network. Some plans may have different cost structures, so it’s always worth calling your plan directly to confirm your coverage details.

This zero-copayment approach reflects Medicare’s recognition that even small out-of-pocket costs can become major barriers to consistent treatment—especially for people on fixed incomes.

Can I start treatment via telehealth only?

Telehealth has opened new doors for Medicare opioid treatment, though some limitations still exist:

For methadone treatment, regulations generally require an in-person evaluation before starting. This is because methadone requires more careful monitoring, especially in the beginning stages.

If you’re seeking buprenorphine (Suboxone) treatment, you’ll find more flexibility. At National Addiction Specialists, we specialize in telehealth opioid treatment that makes it possible to receive care from the comfort and privacy of your home.

Medicare fully covers ongoing counseling, therapy, and periodic assessments via telehealth—including audio-only options when video isn’t available. This is particularly valuable if you:

• Live in a rural area far from treatment facilities
• Face transportation challenges
• Prefer the discretion of receiving treatment at home
• Have mobility issues that make travel difficult

“Telehealth has revolutionized access to addiction treatment,” explains Dr. Elkin. “While there are some limitations, particularly for methadone initiation, telehealth allows us to reach patients who might otherwise go without care due to geographic or mobility barriers.”

During the COVID-19 public health emergency, rules were temporarily relaxed to allow more telehealth options. While some of those flexibilities have changed, Medicare continues to expand telehealth coverage for addiction treatment, recognizing its vital role in expanding access to care.

At National Addiction Specialists, we’re committed to making recovery accessible through our telehealth-based Suboxone treatment for Medicare beneficiaries throughout Tennessee and Virginia.

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Conclusion

The journey of Medicare opioid treatment coverage has come remarkably far in recent years. The 2020 expansion marked a turning point for older adults and people with disabilities who previously faced significant barriers to evidence-based care. Today, we’re seeing real progress in addressing the opioid crisis among Medicare beneficiaries, though important work remains.

When I look at how far we’ve come, I’m encouraged by several key developments:

Medicare now covers the full spectrum of treatment options that addiction medicine specialists like myself know make a difference. From methadone maintenance therapy (previously out of reach for most Medicare patients) to buprenorphine, naltrexone, counseling and comprehensive therapy services, beneficiaries finally have access to the gold-standard treatments that work.

The elimination of copayments at Medicare-enrolled OTPs is truly revolutionary. I’ve seen how even small out-of-pocket costs can prevent people from getting the help they need. By removing this financial hurdle, Medicare has made it possible for more people to start—and stick with—life-saving treatment.

Telehealth flexibility has opened doors for patients who face transportation challenges, live in rural areas, or simply prefer the privacy and convenience of receiving care at home. The ability to connect with providers virtually has been transformative, especially for counseling and ongoing support services.

Yet despite this progress, gaps remain. About 35% of Medicare beneficiaries still live in counties without any Medicare-accepting OTPs. And we know from the data that only about 40% of those who start buprenorphine treatment continue it long-term.

The evidence is clear: patients who receive comprehensive care—medication paired with behavioral therapy and support services—have better outcomes. They’re more likely to stay in treatment and less likely to experience overdose or relapse. This is why at National Addiction Specialists, we’re committed to providing the full range of services patients need to succeed in recovery.

Our telehealth platform makes Medicare opioid treatment services accessible to patients throughout Tennessee and Virginia. Our experienced team specializes in medication-assisted treatment and counseling, accepting Medicare and working to eliminate barriers to quality care.

Recovery is possible at any age. If you or someone you love is struggling with opioid use disorder, please know that Medicare coverage makes effective treatment more accessible than ever before. Don’t wait to get the help you deserve.

Make an Appointment to Treat Addiction
Please don’t hesitate. Make an appointment today.

The path to recovery begins with a single step. Reach out today to learn more about Suboxone for opioid addiction and how Medicare can support your journey toward healing and hope.

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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