Does Medicare Cover Suboxone and Methadone?

Yes. Medicare covers both medications when they're used to treat opioid use disorder, but it pays for them in different ways. Methadone for opioid use disorder is covered only through an opioid treatment program under Part B, or during an inpatient hospital stay under Part A. Suboxone (a brand of buprenorphine combined with naloxone) can be covered at an opioid treatment program under Part B, or through a Part D drug plan when a regular doctor prescribes it and you fill it at a pharmacy.

The path you take changes what you pay, where you go and how often you have to show up in person. Below, we take each path in turn, then cover starting by telehealth, the long-acting injection and Medicare Advantage. If you're helping a parent sort this out, the same rules apply to them.

The short answer, path by path

• At an opioid treatment program (OTP), Part B covers methadone, buprenorphine, naltrexone and nalmefene, plus counseling, testing and other services. The copayment for opioid use disorder treatment at an OTP is $0, though the Part B deductible still applies.

• Through a doctor's office and a pharmacy, Part D may cover buprenorphine (including Suboxone and its generics) and naltrexone. The doctor visits fall under Part B, with the usual deductible and coinsurance.

• In the hospital, Part A covers methadone, buprenorphine and naltrexone during an inpatient stay.

Methadone for opioid use disorder isn't covered under Part D, so you can't fill it at a retail pharmacy with your drug plan (Medicare, Opioid Use Disorder Treatment Services, PDF).

What an opioid treatment program is

An opioid treatment program is a clinic that is specially certified to dispense medication for opioid use disorder. Methadone clinics are the best-known example, but most OTPs also offer buprenorphine and naltrexone. Medicare Part B has covered treatment at OTPs since 2020.

Medicare treats OTP care as a bundle. According to Medicare, covered services at an OTP include:

• Medication approved for opioid use disorder: methadone, buprenorphine (including the extended-release injection), naltrexone and nalmefene

• Dispensing and giving you the medication

• Substance use counseling

• Individual and group therapy

• Toxicology testing (lab tests that check which substances are in your system)

• An intake visit and periodic assessments

• Take-home supplies

• Intensive outpatient program services

• Care coordination and peer recovery support

(Medicare.gov, Opioid use disorder treatment services)

Medicare covers these services as long as they're reasonable and necessary for you. There's no fixed number of months after which coverage simply ends.

What you pay at an OTP

Under Original Medicare, the copayment for opioid use disorder treatment at an OTP is $0. The Part B deductible still applies, which is $283 in 2026 (CMS 2026 premiums and deductibles). So you may owe some or all of the first $283 of Part B services in a calendar year, and after that you wouldn't owe a copayment for your OTP treatment.

This is one of the few places in Medicare where the usual 20% coinsurance doesn't apply. The break is limited to treatment at the OTP itself. If you get similar services from a doctor outside an OTP, the regular Part B copayments or coinsurance and deductible apply (Medicare.gov). For a full walk-through of deductibles, coinsurance and Medigap, see our guide to what recovery care costs on Medicare.

Does Medicare cover Suboxone from a regular doctor?

It can. Many people get buprenorphine from a primary care doctor, a psychiatrist or an addiction medicine specialist rather than an OTP. In that case, the coverage splits in two.

The visits themselves are Part B services. After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount for each visit (Medicare.gov). A Medigap policy, if you have one, may pick up some or all of that 20%.

The prescription goes through your Part D plan. Part D may cover buprenorphine and naltrexone, as well as naloxone and nalmefene, which are used to reverse an overdose (Medicare, PDF). Each Part D plan has its own list of covered drugs, called a formulary, and its own copays. Before you fill a prescription, check whether your plan lists the specific form your doctor prescribed (a film, a tablet or a generic) and which pharmacies are in its network.

The office-based route works well for people who are stable, want to see a doctor they already know and don't need the daily structure of a clinic. It usually costs more out of pocket than an OTP, because the $0 OTP copayment doesn't carry over to a doctor's office.

Does Medicare cover methadone at a pharmacy?

No. When methadone is used to treat opioid use disorder, Medicare covers it only through an OTP under Part B or during an inpatient stay under Part A. Part D doesn't cover methadone for this purpose (Medicare, PDF).

That is why someone on methadone usually visits the clinic often, especially early on. Over time, many OTPs allow take-home doses, and Medicare covers take-home supplies as part of the OTP bundle.

The extended-release buprenorphine injection

Some people prefer a long-acting shot of buprenorphine, given by a clinician, over a daily film or tablet. It removes the daily decision to take a dose and can be easier for someone who has trouble keeping track of medication.

Medicare lists the extended-release injection among the buprenorphine products covered at an OTP (Medicare.gov). If a doctor's office outside an OTP offers the injection, ask the office how it will be billed under your plan and what your share will be, since that can differ from a pharmacy prescription.

Starting treatment by telehealth

Getting to a clinic can be the hardest part for an older adult who no longer drives or lives far from the nearest program. Medicare has loosened the rules on how treatment can start.

At an OTP, buprenorphine can be started through an audio-video visit or an audio-only phone call, without an in-person exam first. Since 2025, methadone can be started through an audio-video visit (Medicare.gov; CMS Medicare Claims Processing Manual, Chapter 17, PDF).

For ongoing care, your home counts as a permanent telehealth site for substance use disorder treatment (42 CFR 410.78). Medicare's broader telehealth flexibilities run through December 31, 2027, and audio-only visits from home are allowed through 2027 (Medicare.gov, Telehealth; CMS telehealth FAQ, PDF).

If you have Medicare Advantage

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and that includes every Medicare-covered OTP service. The difference is that a plan may require you to use an in-network OTP. Plans can also require referrals or approval in advance (often called prior authorization) for some services (Medicare.gov, Compare Original Medicare and Medicare Advantage).

Many Medicare Advantage plans include drug coverage, so a buprenorphine prescription would run through the plan's own formulary. Before starting, call the number on the back of the member card and ask which OTPs and prescribers are in network, what you would pay at each and whether anything needs approval first.

Naltrexone, including for alcohol

Naltrexone works differently from methadone and buprenorphine. It blocks the effects of opioids rather than activating the same receptors, and a clinician will explain when it's safe to start. It's covered at OTPs as part of opioid use disorder treatment, and Part D may cover it when a doctor prescribes it.

Doctors also prescribe naltrexone to help people cut back on or stop drinking. If your parent's concern is alcohol rather than opioids, Part D may cover naltrexone for that purpose as well; check the plan's formulary and ask the prescriber. One more safety point. Stopping alcohol suddenly after heavy, long-term drinking can be dangerous, and the same is true of benzodiazepines (sedatives such as alprazolam or lorazepam). Talk to a doctor before stopping either one. Our guide on how to stop drinking covers this in more detail.

Medication works better with support

Medication treats the physical side of opioid use disorder. It won't rebuild your routines or fill the hours that used to go to using. That is why OTPs bundle counseling, therapy and peer recovery support with the medication, and why doctors who prescribe buprenorphine in an office often suggest counseling alongside it. Our guide to Medicare coverage for substance use counseling explains that side of the benefit.

Accountable supports every path to recovery, including recovery that involves medication. Medication and recovery coaching fit together, and coaching can include coordination with a person's treatment providers when they want it. If you're wondering what that kind of coaching involves, see does Medicare cover a recovery coach.

Questions to ask before starting

• Is this program an OTP, or a doctor's office that prescribes buprenorphine? (That decides whether the $0 OTP copayment can apply.)

• Do you accept Original Medicare, or are you in network with my Medicare Advantage plan?

• Can the first visit happen by video or phone?

• For a prescription, is this exact drug and form on my Part D plan's formulary, and what will it cost at my pharmacy?

• Does anything need approval from my plan before it's covered?

• What counseling and support services come with the medication?

For a broader overview of everything Medicare pays for in recovery, start with our pillar guide, what Medicare covers in recovery.

Common questions

Does Medicare cover Suboxone?
Yes, through two routes. At an opioid treatment program it's covered under Part B. From a regular doctor, the visits fall under Part B and the prescription may be covered by your Part D plan, depending on its formulary.

Does Medicare cover methadone?
Yes, for opioid use disorder, but only at an opioid treatment program under Part B or during an inpatient hospital stay under Part A. Part D doesn't cover methadone for opioid use disorder.

Is there a time limit on medication treatment?
Medicare covers OTP services as long as they're reasonable and necessary. Your care team and your plan decide what is medically necessary for you.

Can my mother start buprenorphine without leaving home?
Through an OTP, buprenorphine can be started by video or by phone without an in-person exam. Ongoing substance use treatment can also take place by telehealth from home.

Does the $0 copayment apply with Medicare Advantage?
Medicare Advantage plans must cover all Medicare-covered OTP services, but they may require an in-network OTP and can set their own cost-sharing for many services. Call the plan and ask what you would pay at an in-network program.

Where Accountable fits

Accountable offers recovery coaching through Medicare in Florida, New Jersey, New York, North Carolina, Tennessee and Texas. A certified recovery coach works with you by video or phone, with a licensed clinician from one of our Insurance Offering Partners (the medical groups that provide clinical services through Accountable) evaluating and overseeing your care. Medicare may cover these sessions as peer navigation under its PIN-PS benefit when the clinician finds a qualified clinical need at an initiating visit. It is session-based and separate from Accountable's monthly subscription. The usual Part B deductible and coinsurance apply, and what you pay depends on your plan (Original Medicare or Medicare Advantage) and any secondary coverage such as a Medigap plan. Your plan makes the final call on coverage. You can start the process for a parent or spouse, and they go through the same clinician visit. Learn more at Recovery coaching through Medicare or call (646) 450-7641.

Sources

• Medicare.gov. Opioid use disorder treatment services.

• Centers for Medicare & Medicaid Services. Medicare Coverage of Opioid Use Disorder Treatment Services (PDF).

• Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 17: Opioid Treatment Programs (PDF).

• Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B Premiums and Deductibles.

• Medicare.gov. Mental health care (intensive outpatient program services).

• Medicare.gov. Compare Original Medicare and Medicare Advantage.

• Medicare.gov. Telehealth.

• Centers for Medicare & Medicaid Services. Medicare Telehealth FAQ (PDF, updated February 2026).

• Electronic Code of Federal Regulations. 42 CFR 410.78, Telehealth services.

This guide explains Medicare rules in general terms and is not legal, medical or billing advice. Coverage depends on your plan and your situation. Last reviewed October 2026.