Does Medicaid Cover Methadone?
- Does Medicaid cover methadone? Find out whether Medicaid and Medicare cover methadone treatment for opioid use disorder and how dual-eligibility coverage works.
Methadone is a drug that prevents cravings and withdrawal symptoms in people who are dependent on opioids. It is often used as part of an opioid treatment program to help people recover from opioid use disorder — often alongside therapeutic services such as counseling.
Medicare and Medicaid coverage for methadone therapy have changed recently because the government is committed to tackling opioid dependency. So, does Medicaid cover methadone? Below, you can find out how Medicaid and Medicare coverage for methadone works.
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Does Medicaid Cover Methadone?
As of December 30, 2020, all states must cover FDA-approved drugs and psychological treatments to help beneficiaries recover from opioid addiction. Therefore, Medicaid covers methadone liquid and tablets.
Your medication must be dispensed by an opioid treatment program licensed by the Substance Abuse and Mental Health Services Administration (SAMHSA). However, you may be able to access methadone treatment through Medicaid in a hospital if it's an emergency.
Does Medicare Cover Methadone?
Original Medicare may pay for methadone if medically necessary, but you must receive treatment through a Medicare-approved opioid treatment program to qualify. Beneficiaries may also be covered for individual and group counseling and other therapeutic services.
Medicare Part B covers outpatient methadone treatment. Beneficiaries do not pay anything for opioid use disorder treatments, but they are liable to pay the Part B deductible. As of 2021, the Part B deductible is $203.
Are Medicare and Medicaid the Same Thing?
Medicare and Medicaid differ because Medicare is a health insurance coverage for older and disabled adults while Medicaid is a federal-state assistance program based on income.
Medicare is mainly for people over 65, but it also covers people with certain disabilities or who need dialysis. Eligibility is not income-based, and treatment is funded through money already contributed by beneficiaries. Enrollees contribute toward the cost of their treatment through deductibles, coinsurance and modest monthly premiums.
Medicaid pays for medical treatment for adults and children on low incomes, and beneficiaries are not usually required to contribute toward the cost of their care. Coverage varies widely between states, but coverage for certain treatments is mandatory for every state. Methadone treatment for opioid dependency is an example of a mandatory benefit for all Medicaid beneficiaries.
Some people have dual eligibility for Medicare and Medicaid, which means that they can enroll in both programs simultaneously. If you are enrolled in Medicare and Medicaid, Medicare will pay for treatment in the first instance if your treatment is covered. Medicaid may cover some or all of the costs you are liable for under Medicare, such as coinsurance payments. Furthermore, Medicaid may fund certain treatments not covered by Medicare.
What Is Covered by Medicaid?
Medicaid provides certain mandatory benefits for enrollees, meaning certain medically necessary treatments will always be funded by Medicaid regardless of where you live. For example, Medicaid will always fund inpatient and outpatient care in hospitals and certain home health services.
Coverage for some treatments is optional, and states can decide whether to fund them for Medicaid beneficiaries. For example, states can choose whether to cover dental treatment and prescription medications.
