Does Medicare Cover Methadone?
This article was updated on: 09/10/2018
What is Methadone?
Methadone is an opioid (narcotic) used to relieve moderate to severe around-the-clock pain, according to the National Institutes of Health (NIH). It’s also used to treat addiction to opioid drugs such as heroin and prescription narcotic pain killers.
Methadone changes the way the brain and nervous system respond to pain, the NIH reports. To help treat opiate addicts, Methadone produces similar effects to opiate drugs, without causing withdrawal symptoms when they stop using these drugs.
When used to treat opiate dependence, methadone must be dispensed by an opiate treatment program approved by the Substance Abuse and Mental Health Services Administration.
Methadone and Medicare coverage
Methadone might be covered under Medicare in certain situations. Original Medicare (Part A and Part B) provides limited coverage for prescription medications. Part A (hospital insurance) might cover methadone you receive for pain treatment or for opiate addiction treatment during an inpatient hospital stay at a Medicare-certified facility. Usually Medicare pays 80% of the Medicare-approved amount after you have paid your Part A deductible. You may be responsible for the Part A deductible and the 20% portion that Medicare does not pay.
Medicare Part B (medical insurance) might cover certain prescription medications administered to you in an outpatient setting, such as a clinic. If you’re looking for Medicare prescription drug coverage, it may be useful to learn about Medicare Part D.
Methadone and Medicare Part D
Methadone may or may not be covered under Medicare Part D, depending on whether methadone would be used to treat addiction. Medicare Part D doesn’t cover methadone when prescribed at a pharmacy to treat drug dependency.
If your doctor prescribes methadone for a different reason, such as for constant severe pain, some Medicare Prescription Drug Plans might cover it.
Medicare Part D prescription drug benefits are available from private insurance companies contracted with Medicare. To get prescription drug coverage, you can enroll in a standalone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
Both types of plans have formularies, or lists of covered medications. Formularies may include brand-name prescription drugs and their generic equivalents. Generic prescription drugs are typically less expensive than brand-name prescription drugs. For example, methadone may be available as a generic prescription drug at a lower out-of-pocket cost than brand-name medication (such as Methadose or Dolophine).
Keep in mind that Medicare plans offering Part D prescription drug benefits have different formularies, which may change from time to time. You can review the medications on a plan’s formulary to make sure it covers methadone or your other prescriptions. If you are enrolled and the plan changes its formulary, the plan will notify you of changes that affect you.
If you’d like more information about your Medicare or Medicare Part D plan options, I’m here to help answer your questions. To speak by phone or email, use the links below to set up a phone appointment or have me email information to you. To find plans right now, just click on the Compare Plans buttons on this page.