Does Insurance Cover The Cost Of Methadone Clinics?

Whether or not insurance covers the cost of methadone clinics depends on the state, the type of insurance, and the clinic itself. While methadone maintenance therapy can be effective for opioid dependence, there are available alternatives of treatment.

What Is Methadone Maintenance Therapy?

Methadone maintenance therapy is a treatment option for people physically dependent to opioids. The therapy is likely to take place in a medical clinic that is fully staffed with physicians, nurses, and counselors.

Methadone maintenance therapy (MMT) gives the person dependent to opioids a daily dose of methadone, usually in tablet or liquid form. The methadone dose will reduce their cravings for opioids, as well as ease their symptoms of opioid withdrawal.

While methadone is addictive like other opioids, it’s much safer than heroin, does not produce euphoria, and is only administered under medical supervision.

Research has shown that methadone maintenance therapy:

  • reduces the number of deaths associated with opioid dependence
  • reduces drug injecting and the spread of HIV
  • reduces criminal activity relating to drug use

Initially, Methadone Maintenance Therapy starts out with a low dose. The size of the dose is then gradually increased until the patient reaches what physicians call the “maintenance dose.”

The “maintenance dose” is just the right amount of methadone needed to adequately relieve withdrawal symptoms, but not produce euphoria or feel-good effects.

Reaching the “maintenance dose” is likely to take days, and the entire MMT process can last months or even years.

MMT is usually a long-term outpatient treatment that may have patients travel to the methadone clinic once a day to receive their daily dose.

While MMT is perhaps the most effective treatment to combat opioid dependence and withdrawal, it may cost people money out of pocket if their insurance doesn’t cover the cost of a methadone clinic.

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How Much Does Methadone Cost Without Insurance?

While the cost of attending a methadone clinic is likely to vary from clinic to clinic, there is a general figure of what methadone costs without insurance.

An entire year of methadone maintenance therapy is estimated to cost the clinic $4,700, or about $12.87 per day (for outpatient services).

On average, the cost of methadone for an individual without insurance is roughly $10-$15 dollars a day, or around $80-$100 per week.

Which type a methadone clinic a person seeks, or how the clinic is funded, will likely factor into the cost of methadone without insurance. It may be best for a person to call the clinic and figure out what the cost will be for an uninsured person.

Many clinics may also use a sliding scale for payment, which means they can adjust the cost of treatment based on a person’s income.

While receiving MMT without insurance may be doable, it’s important to know if any government funded insurance options, like Medicaid or Medicare, cover the cost of methadone clinics.

Does Medicaid Cover Methadone Clinics?

Medicaid is state and federal funded healthcare that covers millions of Americans. It usually covers populations like low-income persons, people with disabilities, pregnant women, and elderly adults.

States implement the coverage of Medicaid, and whether the insurance covers the cost of methadone clinics likely varies from state to state.

However, it can be said that well over half of all US states include methadone clinics in Medicaid coverage. There may be at least 17 states where Medicaid does not cover methadone clinics, so it depends on which state the person seeks treatment.

Research has found that people are more likely to attend MMT when it’s covered by Medicaid than when it’s not. Only 7% of people enrolled in Medicaid in states that do not cover MMT received some form of methadone or buprenorphine treatment.

Nearly half of all people enrolled in Medicaid in states that do cover methadone treatment were able to receive it.

It’s clear that when states cover MMT via Medicaid, people dependent to opioids take advantage of it.

There are regional contacts for people to get in touch with their Medicaid providers to figure out if their insurance covers the cost of methadone clinics.

Does Medicare Cover Methadone Clinics?

Medicare is a federal healthcare provider that covers adults over the age of 65, children with severe disabilities, and others suffering from debilitating disease.

In general, Medicare is only likely to cover substance abuse treatment when it’s offered at a government approved, or Medicare certified, inpatient or outpatient treatment center, or if the treatment is medically necessary.

Medicare likely does not cover methadone clinics.

However, it may cover a stay at an approved inpatient treatment center that may administer methadone as a form of medication assisted treatment, or MAT.

But, reimbursement would only occur if methadone was listed as an eligible medication and was administered at the approved facility.

Whether or not Medicare even covers the cost of methadone, even at an approved facility, varies state by state. It may be best to contact your local Medicare agency for more information.

Does Private Insurance (PPO’s and HMO’s) Cover Methadone?

Private insurance may or may not cover the cost of methadone clinics. Common private insurance plans include HMO and PPO plans.

HMO, or Health Maintenance Organization plans give a person access to doctors and other healthcare options within a particular network. The network is usually made up of a group of providers that have agreed on lower rates with the same standard of coverage and quality.

PPO, or Preferred Provider Organization plans allow more flexibility for the doctors patients can see and usually cost a little more than HMO plans.

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Whether or not an HMO or PPO plan covers the cost of MMT depends on a variety of factors. It can come down to whether or not methadone treatment is medically necessary, or whether methadone is a covered medication included in the plan.

Some plans may cover the cost of methadone, but still require a co-payment.

The coverage of methadone is likely to vary from plan to plan, but a person with a PPO plan may have more options than someone with a more traditional, and less expensive, HMO plan.

There may also be private methadone clinics that deal directly with insurance companies, and may cover part, or all, of methadone maintenance therapy.

It may be best to contact your insurance provider for more information.

Are There Any Free Methadone Clinics?

Methadone clinics that are publicly or state funded may offer low-cost, or sometimes free methadone treatment.

However, it’s unlikely to cost nothing, as the cost of maintaining methadone clinics require facilities to charge patients for services, whether it’s out of pocket or covered by insurance.

The cost of methadone clinics is likely to vary state by state, and the cost of it will generally depend on how it’s funded.

Most methadone clinics in the US are either public or private. Private methadone clinics are likely to cost more, may be covered by some insurance plans, and have no waitlist.

Public methadone clinics may be much cheaper, be paid for by taxpayers, and likely have a long waitlist to get it. The cost, or whether the methadone clinic is free, depends on the location and clinic itself.
Many public clinics may also use a sliding scale for payment, meaning the cost of methadone treatment is based on a person’s income.

Due to the cost and challenges of getting into a methadone clinic, people dependent to opioids may have more success seeking alternative treatments to methadone maintenance therapy.

Alternatives To Methadone Maintenance Therapy

While methadone maintenance therapy is a safe way to manage opioid dependency under medical supervision, there are effective alternatives.

One alternative is the medication Suboxone, which is buprenorphine combined with naloxone – two drugs used to treat opioid dependence and addiction.

Suboxone reduces cravings and has a low risk of abuse. It comes in tablet form and is taken once every 24 hours. Suboxone is safer than methadone because a person cannot overdose from taking too much suboxone.

If a person in methadone treatment takes another opioid, they risk overdose, which can be fatal. Suboxone, however, contains naloxone, which is used specifically to reverse the effects of an opioid overdose.

Suboxone is likely given in an inpatient treatment center, or hospital, as a form of medication-assisted-treatment, or MAT.

MAT is an effective course of treatment to help with opioid withdrawal and dependence, and allows staff at an inpatient treatment center to closely monitor a person’s progress and administer medication accordingly.

Inpatient facilities require the person to stay overnight, and they will likely receive around the clock, 24-hour care.

Many inpatient treatment centers are likely covered by private insurance plans, or even Medicaid, and don’t require a person to travel everyday, sometimes for months or years, to receive their “maintenance dose” of methadone.

Inpatient treatment centers also serve as an effective alternative to MMT because they likely offer behavioral therapies.

Behavioral therapy is a crucial part of battling opioid addiction because it aims to change a person’s thinking and attitudes towards drugs, hopefully building the tools and skills needed for a person to remain sober after treatment.

Call now for information about methadone clinics, or effective alternatives, to help you or your loved one manage the struggle of opioid dependence.


Sources:

US National Library of Medicine – Methadone maintenance treatment

NIDA – Principles of Drug Addiction Treatment: Is drug addiction treatment worth its cost?

SAMHSA – Medication and Counseling Treatment: Insurance and Payment

 

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