Does Medicare Cover Suboxone?
- Medicare can cover Suboxone and other opioid addiction treatments. Medicare Advantage plans (Medicare Part C) also cover opioid addiction treatment, and most plans cover prescription drugs. Learn more about these potential benefits and how to get opioid addiction treatment.
While Original Medicare (Medicare Part A and Part B) doesn’t typically cover prescription medications, Medicare may cover opioid addiction treatment, including drugs like Suboxone. Original Medicare, Medicare Advantage plans (Part C) and Medicare Part D prescription drug plans can also cover Suboxone.
In fact, GoodRx reports that 82% of Medicare prescription drug plans cover at least the generic form of Suboxone, which is buprenorphine/naloxone.
Is It Hard to Get Prescribed Suboxone?
It’s not necessarily difficult to obtain a prescription for Suboxone. While other opioid treatment medications must be prescribed by a specialized treatment center or require an inpatient stay, Suboxone can be prescribed by your doctor for outpatient use.
Suboxone has emerged as among the most preferred treatment medications for opioid addiction as it is less habit-forming than other such medications.
Does Medicare Cover Opioid Addiction?
Medicare Part A provides coverage of MAT (Medication Assisted Treatment) drugs administered during a covered stay at a Medicare-approved hospital or inpatient facility.
Medicare Part B provides coverage for opioid addiction treatment if the treatment is considered medically necessary and is administered by a treatment program that is enrolled in Medicare. The coverage includes medications, counseling, drug testing and individual and group therapy. The Part B annual deductible applies.
Part B also covers MAT drugs including methadone and some buprenorphine formulations such as injections or implants when administered by a practitioner.
More than 18,000 Medicare beneficiaries received addiction treatment services in 2018, with around half being beneficiaries under 65 years old who qualified for Medicare coverage because of a disability or health condition.
Do Medicare Advantage Plans Cover Suboxone?
Medicare Advantage plans cover Suboxone in the same way that Original Medicare covers it.
Medicare Advantage plans are otherwise known as Medicare Part C and are sold by private insurance companies. These plans are required by law to cover everything that is covered by Medicare Part A and Part B. After that minimum coverage requirement has been met, Medicare Advantage plans may then offer some additional benefits not found in Original Medicare.
Prescription drug coverage is among the more popular extra benefits offered by Medicare Advantage plans. And many plans will cover Suboxone and other related medications.
Dental, vision and hearing coverage are some other extra benefits commonly found in Medicare Advantage plans.
Like Medicare Advantage, Medicare Part D plans are sold by private insurers. Part D plans provide coverage for prescription medications and are used as a standalone plan in conjunction with Original Medicare or are included as part of a Medicare Advantage plan.
How Much Does Medicare Drug Coverage Cost?
Medicare Advantage and Medicare Part D plans may or may not require a monthly premium. There is typically a drug deductible along with copayments or coinsurance for certain drugs.
Drugs are separated into tiers, with each tier being covered differently. Common generic drugs will be in one tier and may have different copayment or coinsurance requirements than brand-name drugs or specialty drugs that are on a higher tier.
A Medicare Advantage plan or Medicare Part D plan may cover both the generic and brand name versions of Suboxone, or it may cover one but not the other or it may cover neither forms.
How Do You Enroll in a Medicare Plan That Covers Suboxone?
Medicare Advantage and Medicare Part D plans have certain eligibility restrictions and enrollment periods, so it’s best to reach out to a licensed insurance agent for help. An agent can help you find Medicare Advantage and Medicare Part D plans available in your area that provide coverage for Suboxone and other opioid addiction treatment medications.