Insurance Coverage for Suboxone Treatment
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Last Updated - 6/17/2022View our editorial policy
Suboxone insurance coverage can make treating opioid addiction more accessible and affordable.
What Is Suboxone?
Suboxone is an FDA-approved medication made of two active ingredients: buprenorphine and naloxone. This combination of ingredients reduces opioid cravings and uncomfortable withdrawal symptoms. Because of this, Suboxone can help people achieve long-term recovery from opioid addiction.
Does Insurance Cover Suboxone?
Many insurance plans cover addiction treatment and medications such as Suboxone. The Affordable Care Act (ACA) mandates that insurance providers should offer coverage for substance use treatment. However, coverage will differ depending on your policy and the state where your coverage is provided. Contact your insurance provider to discuss your policy regarding addiction treatment services.
Medication-Assisted Treatment (MAT) and Suboxone Insurance Coverage
Medication-assisted treatment (MAT) is an evidence-based approach to treating substance use disorders (SUD). It combines FDA-approved medications, such as Suboxone, with counseling and behavioral therapies.
MAT treats opioid use disorder (OUD) by addressing the physical and psychological effects. Many insurance providers, including Medicaid and private insurers, recognize the importance of MAT. This is why they include Suboxone and other medications in their plans. However, coverage will differ by state and insurance plan. Therefore, it’s best to consult your insurance provider to learn more about your Suboxone insurance coverage.
How The Affordable Care Act Affects MAT Coverage
The Affordable Care Act (ACA) has increased access to MAT for many struggling with OUD.
Several ways the ACT has impacted MAT coverage include:
- Requiring all plans in the Health Insurance Marketplace to include coverage for SUD services
- Prohibiting insurers from placing arbitrary limits on the length of treatment. This allows patients to continue receiving MAT for as long as medically necessary.
- Increasing access to MAT through Medicaid. This provides coverage for millions of low-income adults who previously did not qualify.
Private vs. Public Insurance Coverage for Suboxone Treatment
Private insurance providers often have different coverage levels for Suboxone treatment. Some private companies may cover some or all Suboxone treatment costs, making it more affordable and accessible for those in need.
Public insurance programs like Medicare and Medicaid also offer coverage for Suboxone treatment. Although it can differ depending on your state’s Medicaid program, most provide some coverage. Still, it’s important to check your state’s requirements before committing to Suboxone treatment.
Medicare and Medicaid
Both Medicare and Medicaid provide coverage for Suboxone treatment.
- Medicare is a federal healthcare program for people over 65 and those with disabilities.
- Medicaid is a state and federal program that provides healthcare coverage for low-income households. However, the extent of coverage may differ across states. There also may be different restrictions or prior authorizations depending on the state. Your state’s Medicaid office can provide more information on your coverage.
Out-of-Pocket Costs for Suboxone Treatment
Suboxone can be an effective tool in achieving and maintaining sobriety. However, it is also essential to understand the related costs one might encounter during treatment.
The out-of-pocket costs for Suboxone treatment will differ depending on several factors, including:
- Suboxone dosage
- Frequency of Suboxone use
- Duration of Suboxone treatment
- Suboxone treatment location
These factors can impact the total cost, whether or not you have insurance coverage. Suboxone treatment may also include additional expenses, such as:
- Doctor consultations
- Lab tests
- Ongoing support services
Other Ways to Save Money on Suboxone Treatment
There are several resources available to those struggling to afford Suboxone treatment. Indivior, Subxone’s manufacturer, offers a program for qualified patients to receive free medication. Additionally, many states and counties have funding for substance use treatment. They may also offer discounts or sliding scales for patients needing financial assistance.
Suboxone Treatment at Orlando Recovery Center
Suboxone treatment at Orlando Recovery Center begins with evaluating each patient’s needs. We will then create a personalized treatment plan from a comprehensive approach. Treatment options include medication-assisted treatment, inpatient rehab, therapy and family support programs. Our continuum of care focuses on addiction’s root causes, providing a foundation for lasting recovery.
Orlando Recovery Center also accepts many insurance plans. Our staff will work closely with you and your insurance provider to verify coverage. Contact a Recovery Advocate today to learn more about our treatment options and how we can help.