Medicare 2026

Methadone and Opioid Treatment Programs Under Medicare: What's Covered and What You Pay

Medicare covers a wide range of services for people with opioid use disorder, including the medications themselves, counseling, therapy, and the wraparound support that helps treatment stick. If you or someone you love is weighing options, the good news is that the coverage is broader than many people realize, and getting care through a Medicare-enrolled Opioid Treatment Program (OTP) can mean no copayments at all.

What Medicare covers for opioid use disorder

Medicare treats opioid use disorder as a medical condition and covers treatment across different parts of the program:

• Part A covers the medications (methadone, buprenorphine, naltrexone) if you're receiving them as a hospital inpatient.
• Part B covers methadone, buprenorphine, and naltrexone when provided in a doctor's office or through an Opioid Treatment Program. Part B also covers nalmefene and naloxone to reverse an overdose.
• Part D may cover buprenorphine and naltrexone prescriptions you fill at a pharmacy.

That layered approach means the setting where you get care often determines which part of Medicare pays — and what you owe.

What an Opioid Treatment Program includes

An Opioid Treatment Program is a specialized clinic that must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent SAMHSA-approved accrediting body. Medicare pays OTPs through bundled payments for Part B patients, which is why your out-of-pocket cost looks different from a typical office visit.

Through an OTP, Medicare covers:

• Medications for opioid use disorder
• Drug testing
• Substance use counseling
• Individual and group therapy
• Intake activities and periodic assessments
• Coordinated care and referrals
• Peer recovery support services
• Intensive outpatient services

These services can also be furnished by mobile units, which helps extend care to people who can't easily get to a clinic.

What you pay

Here's where the setting really matters:

• At a Medicare-enrolled OTP: You pay no copayments for covered services. The Part B deductible still applies — that's $283 in 2026 — but once it's met, there's no further cost sharing for OTP services.
• At a doctor's office or other provider: You pay the Part B deductible plus the usual coinsurance or copayments.
• If you have Medicare and Medicaid: You pay nothing for services you receive through your state Medicaid program.

If you take buprenorphine or naltrexone as a prescription filled at a pharmacy, your Part D plan's cost sharing applies. A helpful backstop: beginning in 2027, your total out-of-pocket spending for covered Part D drugs is capped at $2,400 (it's $2,100 in 2026). The maximum deductible any Part D plan may charge in 2027 is $700, though many plans set it lower.

Telehealth flexibility for starting treatment

Getting started with medication-assisted treatment is easier than it used to be. A provider may be able to start you on buprenorphine without an in-person exam if they can adequately evaluate you using two-way audio and video, or even audio-only, communication. Other medications may still require an in-person exam.

Under the 2025 Physician Fee Schedule rule, beginning January 1, 2025, Medicare permanently allows OTPs to furnish periodic assessments by audio-only communication, and allows the intake for starting methadone treatment to be done by two-way audio-video when the program determines an adequate evaluation can be made that way — within SAMHSA and DEA rules.

How long you can get treatment

There's no arbitrary cutoff. People diagnosed with opioid use disorder can receive Medicare-covered treatment services for as long as they're reasonable and necessary. Recovery takes time, and the coverage is designed to reflect that.

A quick note on enrollment

If you're thinking about how your Medicare choices affect access to this care, keep a few windows in mind:

• Annual Enrollment (Open Enrollment) for 2027 runs October 15 – December 7, 2026, with choices taking effect January 1, 2027.
• If you have Medicaid or Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible people can join an integrated Dual-Eligible Special Needs Plan (D-SNP) in any month.

Original Medicare plus Medigap vs. Medicare Advantage is a personal decision. Original Medicare with a Medigap policy generally lets you see any provider nationwide who accepts Medicare, and Medigap helps with cost sharing — but you'll need a separate Part D plan and premiums vary. Medicare Advantage bundles hospital, medical, and usually drug coverage into one plan, often with extra benefits, but typically uses provider networks and prior authorization. Think about which trade-offs matter most to you, including whether your preferred OTP or prescriber participates.

What's still to come for 2027

The Social Security Administration announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027. The Part D base beneficiary premium for 2027 is $41.33 (used in the late-enrollment penalty calculation; actual plan premiums are set plan by plan).

The 2027 Part B standard premium and deductible and the 2027 IRMAA income brackets have not yet been announced. CMS typically releases them in the fall, usually November. Watch Medicare.gov for the official numbers rather than relying on estimates.

Where to learn more

For official, up-to-date information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. They can help you confirm coverage, find a Medicare-enrolled Opioid Treatment Program, and understand what you'll pay in your situation.

Treatment works, and Medicare is built to support it. Knowing what's covered — and where to get it with the lowest out-of-pocket cost — can make the first step a lot easier.