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Does Medicare cover medical cannabis?

The Drug Enforcement Administration (DEA) categorizes cannabis, also known as marijuana, as a Schedule I substance under the Controlled Substances Act. Medicare does not cover cannabis, although it may cover cannabinoid-based medications.

Individual states vary in the legalization of recreational or medical cannabis within state boundaries.

This article explores Medicare’s coverage of cannabis-based prescription medicine and cannabis-related medications. It also discusses the health conditions that these medications may alleviate, compares THC and CBD, and shows costs.

Is CBD legal? Hemp-derived CBD products with less than 0.3% THC are legal federally but still illegal under some state laws. Cannabis-derived CBD products, on the other hand, are illegal federally but legal under some state laws. Check local legislation, especially when traveling. Also, keep in mind that the Food and Drug Administration (FDA) have not approved nonprescription CBD products, which may be inaccurately labeled.

Share on Pinterest Medicare may cover cannabinoid-based medications.

The Food and Drug Administration (FDA) has not approved cannabis as safe and effective for medical use. It is illegal in many states.

If a person lives in a state where marijuana is legal only for medical use, they must have a medical marijuana card (MMJ). Even if a person lives in a state where medical cannabis is legal, their doctor cannot prescribe it but may recommend its use.

Medicare does not cover medical cannabis or any drugs the federal government has declared illegal. However, in 2018 the FDA approved one cannabis-based prescription medicine and three cannabis-related medications, which Medicare cover:

  • The epilepsy drug Epidiolex is a pure form of cannabidiol (CBD), one of the more than 120 active ingredients, or cannabinoids, found in cannabis. It treats some severe and rare forms of epilepsy.
  • The anorexia drugs Cesamet, Marinol, and Syndros are synthetic drugs based on delta-9-tetrahydrocannabinol (THC), another active component of cannabis.

Research by the National Academies of Sciences, Engineering, and Medicine has provided conclusive evidence that cannabinoids or cannabis can help manage some health conditions. These include:

  • chronic pain
  • nausea and vomiting caused by chemotherapy
  • multiple sclerosis (MS)

Moderate evidence shows cannabis may help with sleep issues, fibromyalgia, chronic pain, low appetite, and Tourette’s syndrome.

A simple way a person can think about the difference between THC and CBD is that THC changes how a person feels, while CBD does not. CBD does not produce the characteristic cannabis high that is typical of THC.

When a person uses medical cannabis, the effects vary depending on what the medication contains. For example, if the medication is CBD dominant, it will contain minimal THC, and a person will not feel high. On the other hand, a medication with more THC may result in a person experiencing a high.

How does cannabis work?

THC and CBD are two chemically similar active components in the Cannabis sativa plant. THC is an abbreviation of the chemical name delta-9-tetrahydrocannabinol and CBD is the shortened form of cannabidiol.

Medications based on the cannabis plant use the plant’s dried flowers, stem, leaves, and seeds.

The human body has hundreds, if not thousands, of cannabinoid receptors that interact with THC and CBD. For example, CBD may help a person \with anxiety, depression, or seizure disorders, while THC can relieve pain, increase appetite, or have a relaxing effect.

Cannabis laws are continually evolving, and states may vary in how they classify THC and CBD.

Medical cannabis, and related programs, are legal in 33 states, Guam, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands as of 2018. If a person lives in a state where marijuana is legal only for medical use, they must have a MMJ.

Each state sets its own rules surrounding the approval and issuance of MMJs. For example, in Washington, D.C., a person would need to take the following two steps:

  1. Make an appointment with their doctor, who may conduct a physical examination and review the person’s medical history. The doctor may confirm the person has a health condition that medical marijuana could help, and will give a signed recommendation.
  2. The person gives the signed recommendation and an application form to the state’s pharmacy board. When a person gets medical marijuana authorization, they can register with the Medical Marijuana Authorization Database to get their MMJ card.

The MMJ card typically lasts for 1 year. After this time, a person may need a follow-up visit to their doctor.

In general, Medicare does not cover medical cannabis. The exceptions are the FDA-approved epilepsy drug Epidiolex, and the anorexia drugs Cesamet, Marinol, and Syndros.

Apart from when a person receives a prescription for FDA-approved drugs, medical cannabis may incur some costs.

Costs vary between states, but may include the following:

  • Out-of-pockets costs related to a health care visit, such as to a doctor’s office.
  • The cost of the medication. Although a person may not have to pay sales tax on the medical cannabis purchase from a medically endorsed retail store, they will generally have to pay the cost of the medication. Costs may vary based on the type and amount.
  • A fee for using the medical cannabis card when getting the medication. This may vary depending on the store policy. Some stores may provide the medication at no charge to a person on a limited income.
  • Cost for the MMJ card, which a person will need to renew each year.

Medicare prescription drug plans may cover or partly cover the FDA- approved cannabis-based medications. People should check their Medicare plan’s drug list before filling a prescription to determine if Medicare covers the cost.

Cannabis is a federally illegal drug. However, medical cannabis and related programs are legal in more than 30 states. Medicare does not cover the cost of medical cannabis but may cover some costs for some cannabis-based or associated medications.

A person who feels that medical cannabis may help with a medical condition can talk with their doctor. Depending on the state where a person lives, medical cannabis may be an option to relieve some symptoms.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Last medically reviewed on September 30, 2020

Cannabis (or marijuana) is a Schedule I substance. Medical cannabis and related programs are legal in more than 30 states, and Medicare may cover some costs.

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

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.

Epidiolex

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 ]]>