Understanding insurance coverage for Suboxone + MAT: A guide for UnitedHealthcare members in New Jersey

While access to care can be a significant hurdle, seeking treatment for opioid use disorder (OUD) is now easier than ever with Medicaid coverage and expanded use of telehealth services. Medicaid covers medications for addiction treatment (MAT), an evidence-based strategy considered the gold standard for treating OUD. If you are a member of UnitedHealthcare’s NJ FamilyCare plan, you can access MAT through Ophelia’s customized treatment plans. Here’s what you need to know about your benefits.

MAT for Medicaid recipients in New Jersey

Under the Affordable Care Act (ACA), all states must fully or partially cover substance use disorder (SUD) treatment options for Medicaid recipients. Additionally, in the growing effort to fight the widespread opioid epidemic, state Medicaid plans are required to include MAT coverage for all members. That means UHC members under the NJ FamilyCare plan are eligible to receive coverage for OUD treatment, which includes:

• Health screenings
• Telehealth
• Counseling and behavioral therapy
• Doctor visits for MAT
• Medications for addiction treatment, like Suboxone (important safety information) 

This is meant to expand access to proven care to those who need it most.

As a member of UnitedHealthcare, you have access to comprehensive coverage for a wide range of services. The NJ FamilyCare plan aims to bring evidence-based care to Medicaid recipients in an effort to “improve accessibility, treatment quality, and health outcomes” for those affected by OUD. Reduced opioid use and emergency visits in New Jersey have already been attributed to increased acceptance and use of MAT services.

Medicaid beneficiaries in New Jersey are not required to enroll in or show documented proof of substance use disorder (SUD) counseling to receive Suboxone for MAT. New Jersey Medicaid plans also do not require prior authorization to begin MAT, so instead of having to wait for approval, you can have access to timely care as soon as you get your prescription.

Does UnitedHealthcare cover Suboxone in NJ?

Under UnitedHealthcare’s NJ FamilyCare plan, you are eligible for evidence-based treatment for opioid addiction. This includes medications like Suboxone, a potentially life-saving drug for individuals with OUD. You can access MAT through participating providers like Ophelia.  

Your benefits and coverage can vary for specific medications and services, so be sure to consult your plan documents or reach out to UnitedHealthcare directly. You may also contact UHC for a list of Suboxone doctors who accept UnitedHealthcare in New Jersey.

Does UnitedHealthcare cover telehealth services?

In 2024 alone, there have been over 1,400 suspected opioid-related overdose deaths. Barriers like distance, lack of local providers, transportation, and the stigma of having OUD can limit access to care and prevent many individuals from seeking treatment. But the expansion of telehealth and other virtual options makes it easier for patients to seek the help they need.

Telehealth has made a world of difference in the fight against the opioid epidemic. When patients are able to meet providers, receive prescriptions, and get referrals from home, they are more likely to begin and remain in treatment. UnitedHealthcare’s NJ FamilyCare plan members can benefit from Ophelia’s telehealth program, including 24/7 clinical support and proven, confidential care.

Understanding your UnitedHealthcare insurance coverage for Suboxone and MAT

Take these steps to navigate your Medicaid coverage with UHC effectively:

• Review insurance policy and formulary: Take the time to review your UnitedHealthcare insurance policy documents and formulary. Look for sections that outline coverage for addiction treatment, prescription medications, and the specific medications used in MAT, such as Suboxone.
• Consult with Ophelia: We can provide additional guidance and support in understanding your insurance coverage with UnitedHealthcare. Our care coordinators can help you navigate the insurance process, answer questions specific to your treatment plan, and assist with any financial concerns. Text or call us today at (215) 585-2144.
• Contact UnitedHealthcare: Reach out to UnitedHealthcare directly to inquire about your coverage for Suboxone and medications for addiction treatment (MAT). You can reach UHC’s support team by calling the number on the back of your insurance card.

Using UnitedHealthcare insurance with Ophelia for effective treatment

Beginning the path to OUD treatment can be a challenging but empowering experience. With Ophelia, UHC Medicaid recipients can benefit from personalized, comprehensive treatment for OUD from a compassionate care team and around-the-clock clinical support. In addition to Suboxone prescriptions, we can help evaluate, manage, and treat psychiatric diagnoses. For people whose needs are beyond our scope, we offer referrals for diagnosing and treating behavioral, psychological, and psychosocial disorders that often occur alongside OUD, such as insomnia and depression.

Get the full-time support you need from our experienced team and receive care from the comfort of your home. When you’re ready to get started, contact UnitedHealthcare customer service or explore your options with Ophelia today.