Does Medicare Cover Methadone? 

Addiction is a health challenge faced by many people in the United States. According to the National Institute on Drug Abuse, over one million seniors in the U.S. suffer from some form of substance abuse disorder. Although alcohol is a commonly abused drug across all age ranges, seniors often face concerns revolving around the use of opioids.

An addiction to opioids may stem from the use of prescribed painkillers to treat a verified medical condition or injury. In time, some seniors find that they have developed a physical and psychological addiction to the effects of opioids. An opioid addiction often requires treatment with a medication like methadone in order to overcome it.

What is methadone?

Methadone is a prescription medication that is used in the treatment of addiction to substances that act on opioid receptors in the brain. Methadone itself is a synthetic opioid. It targets opioid receptors to reduce withdrawal symptoms and cravings when someone quits an opioid substance.

Although methadone is often prescribed to treat heroin addiction, it can also be used to treat an addiction to prescription medications that contain opioid medications. Prescription painkillers often fall into this category. Seniors facing opioid addiction may benefit from methadone.

Methadone treatment is often accompanied by additional substance abuse disorder care. This care may include drug testing, mental health assessments, substance abuse counseling and overdose education. Seniors who are unable to receive services at a clinic may be able to take advantage of some services remotely. Counseling and assessments can often be completed using video chat communications online if in-person care is not a viable option.

How does Medicare Part B cover methadone?

Original Medicare benefits provide coverage for care related to substance abuse disorder in several ways. Most commonly, Medicare coverage for opioid addiction is covered under Medicare Part B, the outpatient benefit. Methadone is administered in an outpatient setting, such as a doctor’s office or substance abuse clinic. Because it is administered by a medical provider,  Medicare Part B will cover the cost. 

Inpatient treatment with methadone

Medicare recipients who receive methadone treatment while admitted to a hospital or skilled nursing facility will have prescriptions covered by Medicare Part A, the inpatient benefit. Medicare Part A supplies limited-time coverage for inpatient care at Medicare-participating facilities. While admitted, all care items are covered, but Medicare recipients are only provided 60 days of full-coverage care in hospitals and 20 days of full-coverage care in skilled nursing facilities.

After these limits have been reached, hospital care is available at a discounted rate for an additional 30 days, but care in a skilled nursing facility can continue for an additional 80 days at a discounted rate. After all Medicare benefits under Part A have been exhausted, covered care can continue if lifetime reserve days are used.

Does Medicare Part D cover methadone?

Medicare coverage for prescription drugs is provided by Medicare Part D. This optional Medicare coverage only covers prescribed medications that can be purchased and picked up from local retail pharmacies. Additionally, any medication covered under a Part D prescription drug plan must be included in that plan’s list of covered medications known as a formulary.

Methadone is a prescription drug, but it is not available to be purchased from retail pharmacies. Instead, it must be administered in a clinical or inpatient setting under the supervision of a medical professional. As a result, methadone is not covered under Medicare Part D.