Medicare Coverage and Medical Marijuana
Written by: Rachael Zimlich, RN, BSN
Reviewed by: Malinda Cannon, Licensed Insurance Agent
Medicare is a federal healthcare program. Only services and treatments approved by the federal program are covered.
States have made medical marijuana legal, but the federal government has not. Private or state plans may offer coverage for medical marijuana, but the federal government has generally not approved it as a legal medication.
There are exceptions. Only a few uses are approved for THC and CBD products.
Does Medicare Cover Medical Marijuana?
The simple answer to this question is no. While there is increasing evidence that marijuana and CBD products can offer therapeutic benefits, marijuana remains a Schedule I substance—illegal in the eyes of the federal government. This means that Medicare typically won’t cover it as a medication. But there are a few exceptions.
Medical marijuana is a generic name given to a class of medications that feature cannabinoids. Cannabinoids occur as more than 80 natural compounds, with cannabidiol (CBD) and tetrahydrocannabinol (THC) among the most well-known. Studies have suggested that these compounds can help treat a number of conditions, including chronic pain and multiple sclerosis.
To date, however, the U.S. Food and Drug Administration (FDA) has not approved any medical marijuana products for wide-scale use. So, when will Medicare cover medical marijuana? Here are the few exceptions:
- Epidiolex, which contains a purified form of CBD for treating seizures specifically associated with Lennox-Gastaut or Dravet syndromes in children ages two and up.
- Marinol (dronabinol) and Syndros (dronabinol), both synthetic THC products that are approved for therapeutic use in people who experience nausea due to chemotherapy, weight loss from AIDS, or for the treatment of anorexia nervosa.
- Cesamet (nabilone) is created from a synthetic compound similar to THC and is approved to treat nausea associated with chemotherapy treatment.
While medical marijuana may show efficacy in treating a variety of conditions, the FDA has only approved the above specific uses. This also means that these are the only cannabinoid treatments that Medicare may cover.
Why doesn’t Medicare cover medical marijuana?
Medicare can only cover FDA-approved medications, so with the exception of the above medications, general medical marijuana use cannot be covered by your Medicare plan.
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Do Medicare Part D Prescription Drug Plans Offer Coverage?
In other words – does Medicare pay for medical marijuana through Part D? After all, this is the section of Medicare that covers prescription drugs, so it would likely cover medical marijuana if it were to be covered.
No; due to the fact that medical marijuana as a whole is not approved by the FDA, it cannot be covered by any part of the Medicare program, including Part D.
How will Medicare pay for medical marijuana treatments that are covered? For specific FDA-approved medications like Syndros, your Part D plan will extend coverage, but these drugs are generally priced in the higher tiers of the formulary. Each Medicare Part D plan has a formulary that must cover protected classes of medications. This means that private drug plans that offer Part D coverage can choose which specific medications to cover, but they must also offer a few standard choices of medications in each drug category or class. Drug plans can also choose how much to charge for these medications, and prices increase in the higher tiers.
Uses for Medical Marijuana
There are a number of ailments medical marijuana may be used for. Most focus on decreasing symptoms or improving overall comfort. Few uses have been FDA-approved, but there is evidence from research papers and ongoing studies that show medical marijuana may offer positive results in a number of areas, including:
- Appetite loss
- Chronic pain
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State Medical Marijuana Laws
As of May 2021, 36 states in the U.S. allow marijuana use for medicinal purposes. There are varying degrees of legality in each state that allows medical marijuana use, with some allowing full access, while others limit access to CBD products that contain no THC—the compound that produces marijuana’s hallucinogenic effects.
Some states have gone even further, opening the use of marijuana to include recreational purposes.
The only states that do not have any allowance for marijuana or cannabinoid products are:
Medical Marijuana vs. CBD
There are hundreds of cannabinoid combinations that all come from the same cannabis plant. Two of the most well-known are THC and CBD. Products that contain THC are known to include the hallucinogenic effect of marijuana, while CBD products do not.
Studies have been done on specific conditions using either, or both, compounds. Some states allow both products, and some limit those that contain THC.
There is little research that has been accepted to conclusively demonstrate the medical benefits of either of these compounds outside of the uses listed above.
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How Do I Use Medical Marijuana?
Medical marijuana can be used in several ways. The FDA-approved uses for epilepsy, cancer support, and anorexia treatment are limited to oral capsules and liquids. But there are a number of products not approved by the FDA that are marketed for medical use in states that allow it.
These products can come in a number of forms, including:
- Oral foods
- Orally ingested oils and butters
- Topical oils and creams
- Inhaled vapors
- Products that are smoked
Medical Marijuana Costs
How is medical marijuana covered by Medicare? And how much will you pay? It depends on several factors.
If you have Medicare, you will have to pay the full cost of your medical marijuana products unless you take one of the few FDA-approved products for its approved purpose.
Prices vary by state, and even by dispensary. If you live in a state that allows limited access to marijuana products for medical purposes, you may first have to pay for a medical access card. These costs can range from $20 to $200 for a card alone.
When it comes to the products themselves, costs for an ounce of medical marijuana can range from $186 to $506 per ounce in state dispensaries.
For the limited number of uses approved by the FDA, Medicare Part D will cover medical marijuana, but out-of-pocket costs such as copayments and coinsurance still apply (You’ll also need to pay your monthly Part D premium). Prescription medical marijuana costs can range from hundreds to thousands of dollars per dose depending on your specific plan. You can use Medicare’s website to find the specific cost in your area with specific Medicare Part D plans, or call a licensed insurance agent to help wade through your options.
Can I choose to self pay?
If you live in a state that allows for recreational or medicinal marijuana use, you may choose to use these treatments and pay for all costs on your own. Some states may also charge you a fee to participate in the state medical marijuana program.
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