Older adults with opioid use disorder (OUD) were more likely to receive medication treatment after Medicare expanded coverage under the 2018 SUPPORT Act, according to new research presented at the 2025 annual meeting of the Gerontological Society of America (GSA) 2025 Annual Scientific Meeting in Boston.

The study found these older adults with OUD were 15.5 percentage points more likely to receive nonintensive outpatient care after the policy took effect. However, treatment completion rates declined, highlighting challenges in program structure, supervision, and reimbursement. Experts said the findings underscore the need for better care coordination and more age-friendly treatment models for this growing, understudied population.

“Medicare’s expanded coverage shows a clear positive effect on increasing access to medication treatment and outpatient services for older adults with OUD,” said Junjie Gai, PhD candidate in the Department of Health Management and Policy at the University of Iowa College of Public Health in Iowa City, Iowa, who worked on the study.

Using federal records from 2015 to 2023, Gai and his team evaluated changes in treatment patterns for those with OUD.

Nonintensive outpatient care included ambulatory counseling, therapy, and pharmacologic treatment.

A Drawback

Despite the rise in outpatient access, treatment completion in nonintensive outpatient programs declined by 11.6 percentage points after implementation took effect in 2020 (P < .01).

“Nonintensive outpatient programs, although easier to access, may not provide the same level of structure, supervision, or support as intensive or residential programs,” said Kanika Arora, PhD, associate professor in the Department of Health Management and Policy at the University of Iowa College of Public Health.

These declines align with previous research — including a 2025 report by the Office of Inspector General — showing that patients who receive medication therapy for OUD in outpatient settings are more likely to discontinue treatment,” Arora said.

Arora said the SUPPORT Act may have expanded access in ways that unintentionally directed patients toward care models that offer less structure.

Another challenge, Arora said, is that Medicare pays for outpatient OUD care through a flat, weekly bundled rate covering up to 9 hours of counseling and therapy. But many patients, especially during the stabilization phase, must receive daily, in-person supervised dosing of medications such as methadone, along with behavioral interventions. Those daily visits are required clinically but are not reimbursed separately, she said.

As a result, she said, “It is possible that the payment may not be enough to cover the treatment.”

Growing, Understudied Population

For clinicians, the findings underscore the need for stronger care coordination and integration across inpatient, outpatient, and supportive services, said Fadi Ramadan, MD, geriatrician and assistant professor of medicine at Tufts Medical Center in Boston, who was not involved in the research.

“Studies have shown that older adults tend to get screened less” for substance abuse and may be more likely to end up in the emergency department before their problem is discovered, Ramadan said.

Treatment outcomes for older adults with OUD also remain poorly understood, he said.

“They’re understudied, and we don’t have a lot of data,” he said. While an estimated 1 million adults aged over 65 years meet criteria for a substance use disorder, “I don’t think we have a lot of information on whether” treatment helps.

Gai, Arora, and Ramadan reported having no relevant disclosures.

Lara Salahi is a health journalist based in Boston.