BHG Accepts Original Medicare

Original Medicare Coverage of BHG Opioid Treatment Programs (OTPs)

Beginning January 1, 2020, opioid addiction treatment at BHG centers will be 100% covered for most Original Medicare beneficiaries.

Your treatment at BHG will be 100% covered with no out of pocket costs if:

  • You are enrolled in Original Medicare Part B (outpatient services)
  • You are diagnosed with opioid use disorder

Covered treatment includes:

  • FDA-approved opioid treatment medications (buprenorphine, methadone, naltrexone)
  • Counseling
  • Behavioral therapy

The combination of these services is often referred to as medication-assisted treatment or MAT.

Original Medicare Enrollment and Eligibility:

Generally, Original Medicare is available for people age 65 or older, younger people with disabilities and people with end stage renal disease (permanent kidney failure requiring dialysis or transplant).

How you can enroll in Original Medicare:

  • Call Social Security at 800 772-1213 (TYY users 800 325-0778), Monday through Friday, from 7AM to 7PM.
  • Online at www.SocialSecurity.gov
  • In person at your local Social Security office.

Frequently Asked Questions:

What is Original Medicare Part B and how can I sign up for it?

Medicare is the U.S. government-run insurance program for those who are 65 years of age or individuals living with certain disabilities. The Medicare program is made up of four parts: A, B, C and D.

Generally, Part A covers hospital services, Part B covers outpatient medical services, and Part D covers prescription drugs. The large majority of Medicare beneficiaries are enrolled in one of more of Parts A, B and D. The only guaranteed OTP therapy that is 100% covered is Original Medicare Part B. If you did not sign up for Original Medicare Part B when you turned 65, you can still enroll. Visit the CMS website to find out about enrollment periods for Original Medicare Part B.

Part C is known as Medicare Advantage and bundles all the services together under a single managed care plan administered by a private insurance company. We are working to secure contracts in 2020, but currently, BHG is not covered by any Medicare Advantage plans. When Medicare Advantage plans do cover BHG treatment, they may not cover OTPs at 100%.

Who can I contact to help me enroll in Original Medicare and/or determine my eligibility?

You can enroll in Original Medicare Part A and/or Part B (which includes opioid addiction treatment) in the following ways:

  • Call Social Security at 800 772-1213 (TYY users 800 325-0778), Monday through Friday, from 7AM to 7PM.
  • Online at www.SocialSecurity.gov
  • In person at your local Social Security office.

How does this benefit impact patients who are dual-eligible for Original Medicare and Medicaid?

For dual-eligible beneficiaries, Original Medicare covers medical services first because Medicaid is generally the payer of last resort, so dual-eligible patients with Original Medicare Part B will be covered with no out-of-pocket costs. BHG handles submitting claims for dual-eligible patients to Original Medicare.

Will Medicare Advantage patients be reimbursed for care at BHG centers?

We are working to secure contracts in 2020, but currently, BHG is not covered by any Medicare Advantage plans. Medicare Advantage is not the same as Original Medicare, so some plans may not waive the patient cost like Original Medicare.

Can I switch from a Medicare Advantage Plan back to Original Medicare?

You can switch once during the open enrollment period that runs from October 15 through December 7 every year. In addition, you can switch Medicare Advantage plans or switch from a Medicare Advantage plan to original Medicare between January 1 and March 31 of each year.

To switch to Original Medicare, contact your current plan, or call 1-800-MEDICARE (800-633-4227).