Medicare for Opioid Use Disorder

Medicare Coverage for Opioid Treatment Programs (OTPs)

Beginning January 1, 2020, opioid addiction treatment will be 100% covered for most traditional Medicare beneficiaries at accredited opioid treatment programs.


Your treatment will be 100% covered with no out of pocket costs if:

          You are enrolled in Original Medicare Part B (outpatient services)

          You are diagnosed with opioid use disorder 

           -AND-

          You meet admission requirements for CATS' Opioid Treatment Program


Covered treatment includes:

          FDA-approved opioid treatment medications (buprenorphine and methadone)

          Addiction Counseling

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Medicare Enrollment and Eligibility

Frequently Asked Questions

Medicare Enrollment and Eligibility:

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with end stage renal disease.


How you can enroll in Medicare:

          Call Social Security at (800) 772-1213 (TYY users 800 325-0778), Mon-Fri, from 7AM to 7PM.

          Online at www.SocialSecurity.gov

          In person at your local Social Security office.


What is Original Medicare Part B and how can I sign up for it?

Medicare is the U.S. government-run insurance program for those who are 65 years of age or individuals living with certain disabilities. The Medicare program is made up of four parts: A, B, C and D.

Generally, Part A covers hospital services, Part B covers outpatient medical services, and Part D covers prescription drugs. The large majority of Medicare beneficiaries are enrolled in one of more of Parts A, B and D. The only guaranteed OTP therapy that is 100% covered is Original Medicare Part B. If you did not sign up for Original Medicare Part B when you turned 65, you can still enroll. Visit the CMS website to find out about enrollment periods for Original Medicare Part B.

Part C is known as Medicare Advantage and bundles all the services together under a single managed care plan administered by a private insurance company.  

CATS Inc is not covered by any Medicare Advantage plans. 


Who can I contact to help me enroll in Original Medicare and/or determine my eligibility?

You can enroll in Original Medicare Part A and/or Part B (which includes opioid addiction treatment) in the following ways:

          Call Social Security at (800) 772-1213 (TYY users 800 325-0778), Mon-Fri,  7AM to 7PM.

          Online at www.SocialSecurity.gov

          In person at your local Social Security office.


How does this benefit impact patients who are dual-eligible for Original Medicare and Medicaid?

For dual-eligible beneficiaries, Original Medicare covers medical services first because Medicaid is generally the payer of last resort, so dual-eligible patients with Original Medicare Part B will be covered with no out-of-pocket costs. 


Can I switch from a Medicare Advantage Plan back to Original Medicare?

You can switch once during the open enrollment period that runs from October 15 through December 7 every year. In addition, you can switch Medicare Advantage plans or switch from a Medicare Advantage plan to original Medicare between January 1 and March 31 of each year.


To switch to Original Medicare, contact your current plan, or call 1-800-MEDICARE (800-633-4227).





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