Does Medicare Cover Medical Marijuana?
Some Medicare Advantage plans (Medicare Part C) and some Medicare Part D prescription drug plans may cover other cannabinoid-based medications, however. Cannabinoids are types of chemicals that are found in marijuana.
More than 31 states allowing the use of marijuana for medicinal purposes in 2018. 1 So what does this mean for your coverage options as a Medicare beneficiary?
Learn more in this guide about how a Medicare Advantage plan could help cover the cannabinoids you need.
Why doesn’t Original Medicare cover medical marijuana?
Though some Medicare Advantage plans and some Medicare Part D plans may cover cannabinoid-based medications, Original Medicare (Medicare Part A and Part B) does not.
The biggest reason why medical marijuana is not covered by Original Medicare is that marijuana is not approved for medicinal use by the Food and Drug Administration (FDA).
A second reason is because marijuana remains federally classified as a Schedule I drug, meaning it is not recognized by the federal government as having any medicinal value.
Some Medicare plans may cover other cannabinoids
Dronabinol is a synthetic form of cannabis that is used to treat the loss of appetite and weight loss suffered by some people with AIDS, Dronabinol can also be used to help treat the nausea and vomiting associated with cancer chemotherapy.
Dronabinol is the active ingredient in brand name drugs Syndros and Marinol, and both drugs may be covered by some Medicare Advantage plans with prescription drug coverage as well as some Medicare Part D plans.
Syndros comes in a liquid form while Marinol comes in the form of a gel capsule. Dronabinol also comes in capsule form as a generic drug that may also be covered by some Medicare Advantage plans and Medicare Part D plans.
Syndros and Marinol are both approved by the FDA and are both classified as Schedule II drugs. 2 This category features drugs with accepted medicinal use that are considered to carry a high risk of addiction or abuse and includes such drugs as oxycodone, fentanyl, morphine and methadone.
Check with your Medicare Advantage or Medicare Prescription Drug Plan carrier to determine if this type of medication (or any others you may need) is included in your plan’s formulary. A formulary is a plan’s list of covered medications.
Are you looking for Medicare prescription drug coverage?
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com. 1
Enroll in Medicare Part D at MyRxPlans.com
How much do cannabinoids cost?
The average retail price of 60 capsules of Dronabinol is reported to be $257. 4 A Medicare Advantage plan or a Medicare Part D plan that covers Dronabinol could help alleviate some of that cost.
Medicare Advantage and Part D plans are sold by private insurance companies, so premiums, deductibles and coinsurance amounts can vary from one plan to the next.
Find a Medicare Advantage plan that offers prescription drug coverage
Are you looking to find a Medicare Advantage plan that covers prescription drugs, such as cannabinoids that are similar to medical marijuana?
Not all plans in all locations offer the same benefits, so it can help to work with a licensed insurance agent to find out more about the plans that are available where you live.
Explore Medicare Advantage plan benefits in your area
Or call 1-800-557-6059 (TTY: 711) 24/7 to speak with a licensed insurance agent.
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1 National Conference of State Legislatures. State Medical Marijuana Laws. (Nov. 8, 2018). Retrieved from www.ncsl.org/research/health/state-medical-marijuana-laws.aspx.
2 Ellis, Lisa. FDA Approves Syndros, First Liquid Form of Cannabinoid Dronabinol. (Aug. 9, 2017). Practical Pain Management. Retrieved from www.practicalpainmanagement.com/resources/news-and-research/fda-approves-syndros-first-liquid-form-cannabinoid-dronabinol.
3 10-minute claim is based solely on the time to complete the e-application if you have your Medicare card and other pertinent information available when you apply. The time to shop for plans, compare rates, and estimate drug costs is not factored into the claim. Application time could be longer. Actual time to enroll will depend on the consumer and their plan comparison needs.
4 GoodRx. Donabinol. Retrieved Nov. 9, 2018 from www .goodrx.com/dronabinol.
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While Medicare does not cover medical marijuana, some Medicare Advantage plans may cover other cannabinoids. Learn more about your coverage options.
Does Medicare Cover Medical Marijuana or CBD Products? No – But There Are Some Options!
As of March 2020, 33 states have legalized comprehensive, publicly available medical marijuana/cannabis programs and 13 have approved use of “low THC, high cannabidiol (CBD)” products for medical reasons in limited situations.
With this widespread adoption of using marijuana for health conditions, including pain management, alleviating anxiety, and improving sleep, it’s become a viable alternative to pharmaceuticals, especially for people with chronic conditions, mental illness, or undergoing chemo.
It’s especially attractive to older Americans who are in constant pain due to arthritis or other conditions, who have trouble sleeping, or are battling mental health issues.
All that said, this leaves the question of how accessible medical marijuana is to Medicare beneficiaries. We’ll dive into the specifics in this piece, including whether or not Medicare provides coverage, the associated costs, and options available.
Does Medicare Cover Medical Marijuana?
As of July 2020, Medicare does not provide coverage for medical marijuana because it is still a federally controlled substance. In order for a medication to be covered by Medicare, it must have FDA approval. But because marijuana is not authorized on a federal level, Medicare will not cover it even if you buy a Part D plan.
So far, the only FDA-approved marijuana-based drug is Epidiolex, which is a medication for children two years old or younger suffering from epilepsy.
Thus, even if your doctor believes marijuana is the best treatment choice for you and writes you a prescription, you will still be required to pay entirely out-of-pocket should you choose to move forward.
Will Medicare Advantage Cover Medical Marijuana?
Similar to Original Medicare, insurance carriers that sell Medicare Advantage plans need to abide by the federal guidelines, so they will not offer coverage for medical marijuana prescriptions. However, some Advantage plans may provide coverage for the use of cannabinoid-based medications such as Epidiolex.
What About Medigap?
Despite the wide array of benefits offered through Medigap plans, they too have to follow federal guidelines and will not provide coverage for medical marijuana.
So, What Are My Options?
Although Medicare does not cover marijuana, Part D may cover cannabis-based medications. Currently, there are four medications available that contain marijuana compounds and have FDA approval:
Marinol and Syndros
A synthetic version of the marijuana compound Dronabinol is contained in the brand-name medications Marinol and Syndros. If you pay out-of-pocket without any drug coverage, you could end up paying around $130 each month for Marinol and a whopping $1,300 for Syndros. Having a drug plan that covers these medications can be a massive benefit.
Cesamet is another medication that contains a synthetic compound similar to those in marijuana. The average out-of-pocket cost for Cesamet is more than $2,000 for a month’s supply.
As mentioned above, Epidiolex has an ingredient derived directly from marijuana. Epidiolex has CBD in it, which can help reduce a plethora of symptoms. However, the average out-of-pocket price of Epidiolex is astronomical, costing more than $32,000 per year.
Does Medicare Cover CBD Oil?
Given the growing popularity of CBD or cannabidiol as a treatment for chronic pain, anxiety, and sleeplessness, it’s a great holistic solution for older adults. Moreover, it doesn’t have the psychotic effects of THC as CBD is typically sourced from industrial hemp plants as opposed to marijuana plants.
Yet, despite the availability of CBD products in health and wellness stores and its proven benefits for managing pain, anxiety, depression, insomnia, and many other unpleasant symptoms, Medicare will not provide coverage for it.
Unfortunately, just like marijuana, CBD is yet to be considered legal on a federal level. Until the FDA approves CBD oil, Medicare won’t help pay for it.
The upside here though is that CBD products are not nearly as expensive as medical marijuana. Depending on factors including strain, dosage, and dispensary you purchase from, the cost can range from $50–$1,500.
Do Your Research
While Medicare does not currently provide coverage for medical marijuana or CBD products, that’s not to say it never will, especially since more states are legalizing both recreational and medical marijuana use, and there’s a push to make it federally legal as well.
But for right now, my best advice is to listen to your doctor’s recommendations and do your research on benefits and costs associated with medical marijuana and CBD products to ensure you’re making a well-informed purchase.
Are medical marijuana and CBD legal in your state? Do you use such products? Why or why not? Do they help you with your particular health issues? What benefit have you noticed since you started using? How do you pay for this type of medication? Please share what you know in the comments below.
Does Medicare Cover Medical Marijuana or CBD Products? No – But There Are Some Options! As of March 2020, 33 states have legalized comprehensive, publicly available medical marijuana/cannabis