What Medicare Coverage Do You Have with Methadone?

Does your Medicare coverage cover the costs of methadone? It can depend on your specific situation.

What is methadone?

Methadone is an opioid that is used to relieve constant pain, but it can also be used to treat an opioid addiction. Some of the drugs that it is used to help with addiction are heroin and prescription pain killers. Since it changes the way that your brain responds to pain, it is used to trick the body with similar effects to opiate drugs. This keeps addicts from having withdrawal symptoms.

Medicare Part A coverage

Medicare may cover methadone under certain circumstances. Medicare Part A may cover it for pain treatment or for opiate addiction treatment. 

Medicare usually pays 80% of the Medicare-approved amount after you have paid your deductible amount. What that means is that you may be responsible for the Part A deductible in addition to the 20% that Medicare does not pay.

Medicare Part B coverage

If it is prescribed to you in an outpatient setting, Medicare Part B may cover the costs. For more details if this applies to you, speak to your doctor before you are prescribed methadone.

Medicare Part D coverage

Medicare Part D may cover methadone, depending on what it is being used for treatment. Medicare Part D doesn’t cover methadone if your doctor prescribes it through a pharmacy for a drug addiction. The only way that Medicare will cover the costs is if your doctor prescribes it for pain. Check you Medicare Prescription Drug Plan to see what’s covered.

There are several options for prescription coverage. You can enroll in a  Part D prescription plan or Medicare Advantage. Medicare plans that offer Part D prescription drug benefits have different formularies, which are subject to change. Make sure that you review the medications on a plan’s formulary regularly.

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