Does Insurance Cover the Cost of Methadone Clinics?

Does Insurance Cover the Cost of Methadone Clinics?

September 5th, 2018

Methadone is the oldest and one of the most commonly prescribed medications for long-term opioid maintenance. Although newer drugs like Suboxone and Vivitrol have been gaining more and more market share, methadone is still a fixture in addiction treatment and helps patients to overcome their withdrawal symptoms and mitigate their cravings for heroin and prescription painkillers. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that  there are over 350,000 Americans taking the drug for long-term opioid recovery. Although the drug has been in use since 1964, its use has increased steadily, particularly over the past fifteen years.

What Are Methadone Clinics?

Methadone is only available through federally approved opioid treatment programs. Patients must receive their initial methadone maintenance at approved clinics; however, those who have been on the drug for an extended period of time may be eligible for take-home doses.

The primary benefits of a methadone clinic include:

  • A safe and discreet place to secure methadone.
  • Less of a chance of diverting and abusing the drug.
  • A medical professional on staff to answer questions.
  • Lower risk and heightened accountability for patients.
  • And more.

Data from the Pew Research Center indicates that there are approximately 14,600 opioid treatment programs that administer methadone, and that this amount has grown less than 25 percent in the last decade, despite rampant escalation of opioid abuse and a record number of overdoses year after year. Opioid-related deaths have quadrupled since 1999, according to data from the National Institute on Drug Abuse (NIDA).

Paying for Treatment at a Methadone Clinic

Methadone has become a fundamental element of the modern opioid treatment process; thus, more and more insurance companies are paying for all or part of the treatment. As of right now, Medicare does not cover the cost of methadone clinics, even though there are approximately 300,000 Medicare patients who have been diagnosed with opioid addiction, and approximately 90,000 are at high risk for overdose. Opioid overdoses killed over 1,300 Americans over the age of sixty-five in 2016.

Other resources such as Medicaid and private insurance can help you pay for treatment at methadone clinics, or at least offset the cost, in the following ways:

Medicaid—A majority of states include funding of methadone clinics in their annual Medicaid budgets, which is ideal for patients with no insurance and limited means of paying for any kind of care. There are essentially two kinds of methadone clinics: public and private. Private clinics rely on dollars from patients and their insurance providers, whereas public clinics are largely state funded. Public clinics may be able to offer discounted or even free methadone treatment to eligible patients.

Private Insurance—Private insurance companies like employer-based Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO) are increasing their coverage options and resources of opioid treatment; however, coverage options for methadone clinics will vary. Factors that can determine coverage include whether or not methadone is medically necessary or whether methadone is a covered medication under the plan, and more. Some plans cover methadone clinics but still require a copayment.

Average Cost Of Methadone

To find out about your exact options and eligibility under Medicaid or your personal insurance plan, talk to your provider or state agency. The average cost of methadone for patients with no insurance is around $100 per week on the higher end.

Start Exploring Your Options Now

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Methadone, when used properly and under the strict supervision of a responsible medical provider, is one of the most effective and trusted means of treating long-term opioid use disorder. Take the first step toward recovery from opioids and find out about your methadone coverage options today. The sooner you call and start a medication-assisted treatment (MAT) regimen, the sooner you can start overcoming your dependency and reclaiming your life. You can do this. Help and a brighter future are closer and more affordable than you may realize.


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