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Medicare · Coverage

Does Medicare cover Suboxone?

Last reviewed October 28, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team

Suboxone is a medicine for opioid use disorder. It combines buprenorphine and naloxone. Medicare covers it, but which part pays depends on where you get it. A pharmacy fill goes through your Part D drug plan. Medicine you get at an Opioid Treatment Program goes through Part B. Here is how each one works and what it costs.

Which part of Medicare pays

The answer depends on where you get the medicine.

  • At a pharmacy: your Part D drug plan may cover buprenorphine. Each plan has its own drug list, called a formulary. Check that yours lists the form your doctor prescribes.
  • At an Opioid Treatment Program: Part B covers buprenorphine, methadone and naltrexone. These programs are clinics that focus on opioid use disorder. Some use mobile units.
  • At a doctor's office: Part B covers these medicines when a provider gives them to you in the office. If your doctor writes a prescription you fill at a pharmacy, Part D covers it.
  • In the hospital: Part A covers them while you are admitted.

Medicare also covers naloxone and nalmefene, which reverse an overdose. Part B covers them, and Part D plans may too.

If you are in crisis, call or text 988. Call 911 for an overdose.

What you pay

With Part D at a pharmacy: you pay your plan's copay or coinsurance. In 2026, no plan can have a drug deductible above $615. Once your out-of-pocket costs for covered drugs reach $2,100 for the year, you pay nothing more for covered drugs.

At an Opioid Treatment Program enrolled in Medicare: you pay no copay. The $283 Part B deductible for 2026 still applies, and that includes the medicine.

At a doctor's office: you pay the Part B deductible and a copay or coinsurance.

  • If you have Medicaid too: you pay nothing for services you get through your state Medicaid program.
  • If you have a Medigap plan: every plan pays some or all of your Part B share.
  • If you have Medicare Advantage: your plan sets its own copays. Check your plan's Evidence of Coverage.

In short: a Medicare-enrolled treatment program has no copay. A pharmacy fill costs your Part D copay, and your yearly drug costs top out at $2,100.

The care that comes with it

Medicare covers more than the pills or film. An Opioid Treatment Program can give you:

  • Your medicine and help taking it
  • Drug testing
  • Counseling, plus one on one and group therapy
  • Check-ins and care planning
  • Peer recovery support from people in recovery
  • An intensive outpatient program, if you need more care each week

Your own doctor can also treat you. Doctors can bill a monthly bundle for counseling and care planning. The medicine is billed on its own, under Part B or Part D.

There is no set end date. You can get treatment as long as it is medically needed.

How to get it covered, step by step

  1. Talk to a doctor or an Opioid Treatment Program. You may be able to start buprenorphine through a video or phone visit, without an in-person exam first.
  2. Check your Part D plan's drug list if you will fill it at a pharmacy. Look for the exact form and strength.
  3. Or choose an Opioid Treatment Program enrolled in Medicare. You can search for one on Medicare.gov.
  4. If your plan says no, ask for a coverage decision. Your doctor can explain why you need this drug. You can appeal if the plan still says no.

Opioid use disorder is treated as part of mental health and substance use care. See how drug plans work in our guide to Medicare Part D.

If you have Medicare Advantage

Medicare Advantage plans must cover every Opioid Treatment Program service that Original Medicare covers. But they can:

  • Require you to use a program in their network
  • Charge a copay for program services

If you join a plan while you are already in treatment, your program must work with both Medicare and your plan. If it does not, you may need to switch programs to stay covered. Check before you change plans.

In short: before you join or switch a Medicare Advantage plan, confirm that your treatment program is in its network.

Common questions about Medicare

Quick answers, fast .

Tap any question to expand. Each links to a fuller standalone answer.

Is Suboxone covered by Part D?

Part D plans may cover buprenorphine, the main drug in Suboxone. Each plan has its own drug list, so check yours for the exact form and strength your doctor prescribes.

Do I pay a copay at a methadone clinic with Medicare?

Not at an Opioid Treatment Program enrolled in Medicare. You pay no copay there, but the Part B deductible still applies. Medicare Advantage plans may charge a copay.

Can I start Suboxone by telehealth with Medicare?

Often, yes. Medicare says you may be able to start buprenorphine without an in-person exam if your provider can evaluate you by video or by phone. You may need an in-person exam for other medicines.

Does Medicare cover naloxone?

Yes. Part B covers naloxone and nalmefene, which reverse an overdose. Part D plans may also cover them at a pharmacy.

References

  1. Medicare.gov, Opioid Use Disorder treatment servicesWhich part pays for each medicine, and the no-copay rule at treatment programs.
  2. Medicare.gov, Costs for Medicare drug coverageThe 2026 Part D deductible limit and the $2,100 yearly cap.
  3. Federal Register, CY 2021 Physician Fee Schedule final ruleMonthly bundles for substance use treatment, with medicine billed on its own.
  4. Medicare.gov, Mental health and substance use disordersAll the substance use services Medicare covers.

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