What opiate addiction treatment costs

Federal law requires every state Medicaid program to cover medications for opioid use disorder, along with the counseling that goes with them. That includes methadone, buprenorphine and naltrexone.

What you pay out of pocket on Medicaid is usually small. States can charge copays, but for most people they are limited to low amounts. The details are on our page about Medicaid and opioid treatment.

Medicare has covered opioid treatment program services, including methadone, since 2020. If you are 65 or older, or you get Medicare because of a disability, see Medicare coverage for opioid treatment.

With either program, the question to ask a clinic is simple: “Do you take my plan, and are you taking new patients?” Not every clinic accepts every plan.

If you are not sure whether you qualify for Medicaid, apply anyway. You can apply any time of year, through HealthCare.gov or your state agency, and the application itself is free.

Plans sold through the Affordable Care Act marketplace must cover substance use disorder treatment as an essential health benefit. Most job-based plans cover it too.

A federal parity law says that when a plan covers this care, it cannot make the rules tighter than the rules for medical care. That applies to copays, visit limits and prior approval.

Covered does not mean free. Your share depends on your deductible, your copay or coinsurance, and whether the clinic is in your plan’s network. Out-of-network care is where the big surprise bills come from.

Our page on using private insurance for treatment walks through the call to your insurer and what to do if a claim is denied.

No insurance does not mean no treatment. It means a few more phone calls.

• Check Medicaid first. You can apply any time of year, and many adults qualify on income alone.
• Look at marketplace coverage. Losing a job or other coverage can open a Special Enrollment Period.
• Find a community health center. What you pay there depends on your income.
• Ask about state-funded treatment. Every state gets federal money to treat people who cannot pay.

Each of these has steps on our page about getting treatment with no insurance. Programs paid for with public money are explained in free and state-funded programs.

You can also call SAMHSA’s National Helpline at 1-800-662-4357. It is free, confidential and open 24 hours a day. The people who answer can refer you to local programs, including ones for people without coverage.

You are allowed to ask what care will cost before you agree to it. A program that will not answer plainly is telling you something.

1. Get the clinic’s details. Ask for the name of the service they recommend and how long they expect it to last.
2. Call your plan. Use the member number on the back of your card. Ask if the clinic is in network, if prior approval is needed, and what your share will be.
3. Ask the clinic for the total. That means every charge: intake, visits, medication, drug tests, lab work, and room and board if you would stay overnight.
4. Get it in writing. Write down the date, the name of the person you spoke with and any reference number.

If you are paying on your own, federal rules give you extra help. A provider usually has to give you a written good faith estimate when you ask for one or when you book care at least 3 business days ahead.

If the final bill comes in at least $400 above that estimate, you may be able to dispute it. The federal No Surprises Help Desk at 1-800-985-3059 can explain how.

Keep one more thing in mind when you compare quotes. The first week is rarely the whole cost. Medication treatment often continues for months or years, so ask what a typical month looks like once you are settled, not only what the first visit costs.

When you are ready to compare real programs, our treatment directory lists centers by state. Ask each one the same questions.