Original Medicare (Parts A & B): Opioid Use Disorder (OUD) Treatment Services

Treatment for opioid use disorder (OUD). Tolerance and dependence are physical, addiction is psychological, and both need support to overcome.

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Cost
No copays for provider services; Part B deductible still applies
Prior Authorization Required
No
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

Talk to your loved one's healthcare provider to find out where to go for these services, or click here to find a nearby program.

  1. Obtain a provider referral for opioid treatment.

  2. Schedule an intake assessment appointment with an OUD treatment provider that accepts Medicare.

  3. Attend the appointment and complete the intake. Develop a care plan and schedule future visits for counseling, therapy, medications, and/or activities.

  4. Attend all visits and complete the program, as designed.

    • Program completion depends on meeting individualized goals.

  5. Arrange ongoing maintenance visits with the OUD treatment provider or your loved one's primary care provider and attend those as scheduled.


For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.

Availability
As certified by a provider and ongoing until goals are met
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Opioid use disorder (OUD) comprises:

OUD can occur in older adults, especially those who use opioids for chronic pain control.

OUD treatment includes the following services:

OUD programs are conducted at both inpatient and outpatient hospital-based and sometimes university-based treatment sites and rehabilitation centers, and may be delivered in conjunction with drug therapy at independent MAT clinics (once commonly referred to as “methadone clinics” or “drug depots”).  In more rural settings, outpatient counseling may be delivered in more community-based settings such as activity centers, churches, and legion-type facilities (VFW, Elk’s Club, etc.).

Not all OUD programs are medication-assisted.  There are also programs (commonly called “detox”)  that rely on abstinence-based treatment wherein there is no medication transition, though these are typically inpatient programs lasting from 21-28 days or residential programs lasting more than 30 days.  However, there are inpatient and residential programs that are also MAT.  Be sure to ask about the facility’s approach (abstinence or MAT) before intake and admission.

Outpatient programs, which are generally MAT, may vary in intensity and duration, but typically last anywhere between 3 months and a year.

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