Does Medicare Cover Methadone Clinics?
Navigate Medicare coverage for methadone clinics and opioid use disorder treatment. Get clarity on covered services, costs, and finding support.
Medicare plays a significant role in ensuring access to healthcare services. Understanding its coverage for specific treatments, especially for opioid use disorder (OUD) at facilities like methadone clinics, is important for beneficiaries.
Medicare Coverage for Opioid Use Disorder Treatment
Medicare covers treatment for Opioid Use Disorder (OUD), including services at methadone clinics, formally known as Opioid Treatment Programs (OTPs). This benefit, effective January 1, 2020, significantly expanded access to care. Medicare Part B provides this coverage.
OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved body to be eligible for Medicare coverage. This ensures adherence to federal standards. Medicare pays certified OTPs through bundled payments for OUD treatment services.
This structured approach ensures beneficiaries receive a continuum of OUD care. The bundled payment model encourages integrated service delivery. Before 2020, Medicare did not directly reimburse OTP services.
Specific Services and Facilities
Medicare’s coverage for Opioid Treatment Programs includes a range of services bundled under the OTP benefit. These services are part of a comprehensive OUD treatment approach. They include U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medications, such as methadone, buprenorphine, and naltrexone.
Covered services also involve medication dispensing and administration. Behavioral health support is a central component, with Medicare covering substance use counseling, and individual and group therapy sessions. These services can be delivered in-person or through two-way audio-video communication.
Further covered services include toxicology testing to monitor progress and adherence. Intake activities and periodic assessments are also part of the bundle, ensuring treatment plans are reviewed and adjusted. Medicare also covers:
Intensive outpatient program services
Coordinated care and referral services
Patient navigational services
Peer recovery support services
Overdose education and take-home supplies of opioid antagonist medications like naloxone.
Understanding Costs and Finding Providers
While Medicare covers OUD treatment at certified Opioid Treatment Programs, beneficiaries should be aware of potential out-of-pocket costs. For services from a Medicare-enrolled OTP, beneficiaries typically do not pay copayments for bundled services.
The Medicare Part B deductible still applies to supplies and medications received through an OTP. For 2025, the Part B annual deductible is $257. This must be met before Medicare pays its share for covered services and supplies. After the deductible is satisfied, Medicare covers a significant portion of approved costs.
To locate Medicare-approved Opioid Treatment Programs, individuals can use official Medicare resources, such as the Medicare.gov website’s provider search tool. The Centers for Medicare & Medicaid Services (CMS) also maintains a public dataset of enrolled OTP providers. Consulting healthcare providers can also help identify certified programs that accept Medicare.