Does Medicare Cover Suboxone? 

Opioid addiction is a huge problem in the United States. This form of addiction does not discriminate based on age, gender, income level or region. In fact, seniors often find themselves the victims of opioid addiction as a result of being prescribed pain medications after an injury or illness.

Some seniors are not provided with proper warnings regarding the potential for addiction when being prescribed opioid pain medications. Others may find that forgetting a dose leads to doubling up on pills, a practice that can lead to serious health complications, addiction and overdose. Over time, the use of opioid medications, even when taken as prescribed, can potentially lead to addiction.

How is opioid addiction treated?

An addiction to opioids can be treated in several different ways, but there is no one-size-fits-all solution. In some cases, individual and group counseling may provide the support needed to stop opioid usage entirely. Counseling sessions may be provided in an outpatient setting, but many inpatient addiction treatment facilities also offer counseling services.

For many seniors who have developed a dependence on opioids, medicinal support is also required. Prescription medications like Suboxone (buprenorphine and naloxone) can be used to reduce the discomfort and danger of physical withdrawal symptoms when stopping opioid-containing substances. Suboxone is a sublingual medication, so it is placed under the tongue where the medication dissolves and is absorbed into the bloodstream.

Does Medicare cover Suboxone?

Because opioid addiction can affect anyone at any age, it’s important for Medicare recipients to see if their plans cover Suboxone. For many, Suboxone is a covered medication, and Medicare benefits provide access in several different ways.

Outpatient coverage for Suboxone

When provided in a clinical setting, Suboxone is covered by Medicare insurance under Part B. This is outpatient insurance, and most services provided under Medicare Part B are paid by the program at 80%. This leaves a 20% coinsurance cost for Medicare recipients. Medicare coverage through Part B is optional insurance, and most people will have a deductible to meet as well as monthly premiums.

Inpatient coverage for Suboxone

Suboxone administered to Medicare recipients who are admitted into a hospital or skilled nursing facility is covered by Medicare Part A. Most Medicare recipients receive Medicare Part A coverage with no monthly premium required. The cost of Medicare Part A is covered by paycheck deductions that have been contributed during a retiree’s working years. Medicare Part A does, however, require a deductible to be met before benefits apply toward inpatient treatment.

Prescription drug coverage for Suboxone

Despite the fact that Suboxone is meant to help free people from addiction, Suboxone itself is classified as a Schedule III controlled substance by the United States Drug Enforcement Agency (DEA). This means that it is not available over the counter, and prescriptions for Suboxone are limited.

Medicare Part D supplies coverage for Suboxone under Original Medicare, but in order to know your plan’s coverage limitations, you will want to consult with its formulary. This is a list of covered medications under your Part D prescription drug coverage, and it will include additional information regarding restrictions for certain medications.

Do Medicare Advantage plans cover Suboxone?

Medicare Advantage plans must provide the same level of coverage as Original Medicare. Most plans also include Part D prescription drug coverage. Medicare Advantage plan providers do have the option to include additional benefits not found in Original Medicare. This could mean that seniors in need of medical support for opioid dependence may have access to additional coverage. Check with your plan directly for more information. 

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