Medicare's Coverage for Substance Abuse Treatment: Details
In a bid to address the growing issue of substance misuse, Medicare offers extensive coverage for various treatment options. This includes inpatient and outpatient care, as well as prescription drugs necessary for the treatment of opioid dependence.
Original Medicare (Parts A and B) covers inpatient care in the hospital for substance misuse treatment and outpatient treatment through Part B. Medicare Part D provides prescription drug coverage, which includes coverage for medications like methadone and Suboxone, crucial components in the treatment for opioid use disorder (OUD).
Methadone, specifically, is covered by Medicare for OTP services as an opioid agonist, although it might not be covered by all Medicare Advantage plans for inpatient settings without a Part D plan. Suboxone, used for medication-assisted treatment, is typically covered by Medicare Part D prescription drug plans.
However, it's essential to note that coverage details can vary by Medicare Advantage plan, and some may have network restrictions or specific requirements for certain medications. It's advisable to check with your specific Medicare Advantage plan to confirm coverage for these medications.
Medicare Advantage (Part C) also covers substance misuse treatment, but patients may need to use in-network providers. Services during partial hospitalization may include psychotherapy, occupational therapy, self-administered prescribed medication, personalised activity therapy, family counselling, and inpatient rehab.
Out-of-pocket costs for Medicare Part A in 2025 include a 20% coinsurance for mental health services received in a hospital, a $1,676 deductible for each benefit period, 0% hospitalization coinsurance for the first 60 days of each benefit period, $419 hospitalization coinsurance for days 61 to 90 of each benefit period, and $838 per 'lifetime reserve day.' Part B out-of-pocket costs include a $185 monthly premium, a $257 annual deductible, and 20% coinsurance. If a person is enrolled in the partial hospitalization program, they may have to pay an additional coinsurance to the hospital.
In outpatient settings, Medicare covers a program called Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention approach aimed at preventing non-dependent substance use from developing into a substance use disorder.
It's crucial to remember that opioids have the potential for addiction and misuse. Following prescription directions, avoiding mixing opioids with certain substances, and storing medications securely are all important steps in ensuring safe use.
For more information and guidance on navigating Medicare, resources can be found at the Medicare hub. It's always recommended to consult with healthcare providers and Medicare representatives for personalised advice.
[1] Medicare.gov, "Medicare Coverage of Substance Use Disorder Treatment," https://www.medicare.gov/coverage/substance-use-disorder-treatment [2] Medicare.gov, "Medicare Coverage of Methadone and Suboxone," https://www.medicare.gov/coverage/methadone-and-suboxone-coverage
Medicare's coverage extends to a variety of health-and-wellness and mental-health services, including therapies-and-treatments for addiction, such as inpatient and outpatient care for substance misuse. Methadone, a crucial component in the treatment for opioid use disorder (OUD), is covered by Medicare Part D, while Suboxone, used for medication-assisted treatment, is typically covered by these prescription drug plans. However, it's vital to confirm coverage details with your specific Medicare Advantage plan, as some may have network restrictions or specific requirements for certain medications.
