Medicare could cover Methadone for patients that require the drug in an inpatient setting. One in three adults on Medicare uses opioid pain killers for some type of chronic pain.
Opioid medications are a class of drugs that come from opium. Although, these synthetic opioids are from your medical provider to treat acute, chronic and/or cancer pain.
When uses correctly, opioid pain medications work by attaching to the brain’s pain receptors, therefore reducing pain. Additionally, your body can build up a tolerance to the pain pills and start requiring stronger medications.
What many don’t anticipate is an addiction that comes along with taking pain medications. Even if the pain medication is from your healthcare provider, this can happen to you.
Opioid addiction doesn’t discriminate. Although, anyone taking daily opioids is at risk for addiction as your body becomes physically dependent.
Eventually, withdrawal symptoms can present if you abruptly stop taking the medication. In some cases, healthcare providers will provide an RX, methadone, to prevent opioid withdrawal symptoms.
Medicare Can Cover Methadone
With Medicare Part A; in a hospital and on methadone for pain or drug addiction, then the medication may have coverage. Then, Medicare Part B provides coverage for methadone if the medication is in an actual methadone clinic.
Part D is a standalone plan that gives you coverage on prescription drug costs. Additionally, this plan alone can save you hundreds if not thousands on your cost of prescription drugs each year.
A Part D Plan will likely cover methadone if used for pain; however, it won’t cover the cost of the medication used for other reasons.
Beneficiaries can save money is by purchasing a Medicare Part C Plan, AKA Medicare Advantage Plan. However, you can have a plan with value by purchasing a Medicare Supplement Plan.
Medicare Part C Plans are known as Medicare replacement plans as they take over the coverage of Traditional Medicare benefits. They also have some added benefits like vision, hearing and prescription drug coverage.
Medicare Advantage Plans can be cheaper by having lower deductibles and copayments. They oftentimes can have policy limitations and may require prior authorization for treatment and drug coverage.
Although, a better option to Medicare Advantage Plans is the Medicare Supplement Plans.
These plans work alongside your Traditional Medicare benefits. Depending on which plan you choose, coverage on deductibles, copayments, coinsurance and other out of pocket medical costs is possible.
The Purpose of Methadone and How Medicare Will Cover Cost
Methadone is a synthetic opioid analgesic that can provide long-term pain relief. The medication itself is stronger than morphine. Medicare may cover Methadone in certain situations.
In most cases, the medication can be a form of treatment for opioid and heroin addiction. Also, the medication itself weakens the urge to use opioids and can prevent withdrawal symptoms. The medication likely lasts longer than most regular opioid prescriptions.
Methadone comes from a pain physician, a certified psychiatrist specializing in addiction, or a Methadone Clinic.
The Risk for Opioid Dependence
When a person has an uncontrollable urge to use a substance, despite adverse effects, this is an addiction.
In the late ’90s, pharmaceutical companies were targeting prescribers; also, advising them that patients wouldn’t become addicted to strong pain relievers. This led to a rapid increase in written prescriptions.
Despite the promise of the pharmaceutical, opioids became more and more popular as a drug of misuse. This is due to the euphoric feeling patients felt when taking the medications.
Since being on the market, despite all the warnings out there, synthetic opioids have led to countless overdoses.
As of 2017, about 1.7 million Americans alone dealt with opioid drug addictions. Then more than 47, 000 individuals lost their life due to opioid overdoses.
There are several pre-existing factors that can contribute to:
- If the patient has any drug or alcohol dependence
- the patient currently smokes cigarettes products or has ever been a user of tobacco products
- If the patient has a history of depression or anxiety
Research has shown the risk of tolerance and abuse now makes opioids a poor choice for chronic pain. Although, providers are using these powerful medications more for acute pain instead of chronic. Then, using other treatment options for those suffering from chronic conditions.
If given opioid pain medication as a treatment option from your physician, it’s important to use them only as intended; to treat pain.
Recognizing Signs of Opioid Addiction and Withdrawals
With opioids being more and more common, it’s important to recognize if someone is suffering from addiction. Medicare will cover Methadone in certain situations. To better understand how your prescription plan pays, contact the company or agent that sold you the policy.
Symptoms of addiction include:
- An obsession with their pain medications
- Poor performance at work
- The need to take more to achieve the effect
- Failed success in trying to taper off pain medication
- Behavior that exhibits less interest in doing things like socializing, hobbies and engaging with family.
- Lack of motivation
- Signs of depression or an increase in anxiety
- Weight loss
- Loss of concentration
- Mood swings and substantial behavioral changes
- A distorted perception of reality
- Confusion and/or disorientation
- Stealing from loved ones
- Slurring of words or slowed speech
- Once addicted to opioids, withdrawals symptoms can begin in 12 hours of the last dose.
While signs of addiction may be harder to recognize, withdrawal symptoms are much easier to realize.
Withdrawal symptoms include:
- Severe cravings
- Irritation and/or agitation
- Flu-like symptoms including sweating, muscle aches, and pains and cramping
- Nausea and/or vomiting
- Suicide ideation
If you know someone suffering from opioid addiction, call a nationwide hotline for help. Additionally, if they have Medicare to cover the Methadone, getting them help is extra important.
Fast Facts About Opioid Addiction
Every year, millions of Americans are given opioid pain medications for the management of pain.
Here are some staggering facts regarding the opioid crisis in our country:
- 214 million pain medication prescriptions were given in 2016
- In the same year, greater than 11 million people had opioids
- More than 1,000 people are in a hospital setting each day for misusing opioids
- 1 in 5 people had prescription opioids for a long period of time for noncancer issues.
- Opioid abuse continues to claim more lives than illicit drugs
Over the last 2 years, more prescriptions for addiction medications have been given than actual opioid pain killer prescriptions.
It’s important to know the risks and benefits of any medication. Even more so when it’s an opioid. Also, make sure to discuss any and all concerns with your healthcare provider.
More Help with Your Medicare Benefits
If you have any questions regarding how Medicare will cover Methadone, we’d be happy to help. We can also walk you through the application process for coverage Medicare doesn’t provide.
Traditional Medicare benefits are best with a Medicare Supplement Plan and a Medicare Part D prescription drug plan. However, we recommend discussing your options with one of our brokers. They can help you find your best policy.
Call our toll-free number or click on our online forms for more information. Our licensed insurance agents are ready to answer any questions you may have and help you start saving money today.