Does Medicare Cover Medical Marijuana?
Key takeaways:
Medical marijuana is legal in 37 states, 4 U.S. territories, and the District of Columbia.
Marijuana remains illegal at the federal level, which is what prevents Medicare — and other insurers — from covering it.
In the states where medical marijuana is legal, buying from a state dispensary can be costly.
Using marijuana to relieve symptoms related to chronic and terminal medical conditions is becoming increasingly accepted in the U.S. In fact, nearly 3 in 4 states have legalized its use. But as long as marijuana remains illegal at the federal level, healthcare providers can’t prescribe it, and Medicare can’t cover it.
For some people, medical marijuana might be an attractive substitute for prescription opioids to reduce chronic pain. It may be a cheaper alternative as well. Still, for most medical conditions, research is limited and health risks are possible.
Marijuana, also known as cannabis, comes from the cannabis sativa plant. Two of marijuana’s best known cannabinoids are tetrahydrocannabinol (THC), which produces a “high” sensation, and cannabidiol (CBD), which has relaxing effects but not a high. Medical cannabis can have different proportions of THC and CBD.
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In which states is medical marijuana available?
In February 2022, Mississippi became the 37th state to pass legislation legalizing marijuana for medical use. Medical marijuana is also legal in four U.S. territories and the District of Columbia. But marijuana remains illegal nationally because federal law continues to consider it a Schedule 1 controlled substance.
Controlled substances are medications and substances that the federal government says have a higher risk for dependence and misuse. Schedule 1 controlled substances are considered to have “no currently accepted medical use and high potential for abuse,” according to the U.S. government definition. Because of this, federal law prohibits healthcare providers from prescribing marijuana.
Does Medicare cover medical marijuana?
Because of its illegal status at the federal level, Medicare doesn’t cover medical marijuana.
But a recent survey by MedicarePlans.com found that 2 in 3 Medicare beneficiaries said that Medicare should cover medical marijuana. About 6 in 10 of those who support coverage said the reason is they believe cannabis can be effective when other treatments fall short.
Does Medicare cover FDA-approved cannabinoid-based medications?
There are three FDA-approved prescription medications that contain cannabinoids. Healthcare providers can prescribe them and Medicare may cover them, if you’re eligible.
The FDA-approved cannabinoid-based medications are:
Epidiolex: This medication is approved to treat rare forms of epilepsy known as Lennox-Gastaut or Dravet syndromes.
Marinol and Syndros: These are brand names for dronabinol. They treat nausea and vomiting in people receiving chemotherapy for cancer. They’re also used to treat people with HIV/AIDS who have anorexia or significant weight loss.
Cesamet (nabilone): This medication is also FDA approved to treat nausea and vomiting in people receiving chemotherapy for cancer.
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These medications may be included in Medicare Part D formularies and Medicare Advantage plans. Epidiolex has the most coverage, with nearly all Medicare private plans covering it, according to FormularyLookup.com. But you’re likely to face restrictions such as prior authorization or step therapy. About 1 in 3 private plans cover Marinol and Syndros. You also may have to get preapproval or try another therapy first before your plan will pay for this medication.
Check your plan to see if these medications are covered and how much you’ll pay.
Can healthcare providers prescribe medical marijuana?
No. By law, healthcare providers can’t prescribe medical marijuana. But in states where medical marijuana is legal, healthcare providers can recommend it or make a referral to a state dispensary. A dispensary is a designated store where marijuana is sold.
Medical marijuana may be useful for the same reasons as the FDA-approved cannabinoid medications. Medical marijuana may also be useful in some people for other medical conditions, including:
Chronic pain from various medical conditions
Anxiety
Depression
Glaucoma
Crohn’s disease
Multiple sclerosis (MS)
Amyotrophic lateral sclerosis (ALS)
Epilepsy and seizures
Parkinson’s disease
Anorexia
Insomnia
What does medical marijuana cost?
In some places, costs related to getting marijuana may exceed the cost of the actual marijuana. In its State of the States 2021 report, the advocacy group Safe Access Now estimated that medical marijuana customers at state dispensaries were likely to pay as much as $350 before they could access and pay the cost of marijuana.
While fees vary among states, you may pay fees related to obtaining medical marijuana, including:
A visit to a healthcare provider’s office to certify that you are eligible to use medical marijuana
A fee for the medical marijuana license
A fee for using the medical marijuana card in the store
Some of these fees may need to be paid annually or even semiannually.
Can I use my health savings account (HSA) to pay for medical marijana?
The IRS says marijuana isn’t an eligible health savings account expense because it is illegal under federal law. It doesn’t matter whether it’s for medical or recreational purposes.
Should I tell my healthcare provider if I’m taking medical marijuana?
Yes. It’s a good idea to tell your healthcare provider that you are using marijuana — medical or otherwise. But talking to your provider about marijuana or CBD use can be intimidating and hard to navigate.
Your healthcare provider and pharmacist will want to know about any supplements or vitamins you take because it helps them screen for possible drug interactions. And marijuana is no different. If you’re taking other medications that affect your nervous system, marijuana may have risks that outweigh its benefits.
If you’re a U.S. veteran, Veterans Affairs (VA) healthcare providers cannot deny you care if you use marijuana. And, if you use medical marijuana, they can discuss the risks and benefits with you. But because it’s federally illegal, VA providers can’t recommend its use or prescribe it. If applicable, they will record marijuana use in your confidential medical record for treatment planning purposes.
When will medical marijuana be covered by insurance, like other prescription medications?
Medicare won’t cover medical marijuana unless marijuana is legalized at the federal level. This is what’s required for potential FDA approval and regulation.
The U.S. House of Representatives passed two bills in 2020 and 2022 to legalize marijuana, but neither passed in the U.S. Senate.
Can I assume that nonprescription cannabis products are labeled accurately?
Not necessarily.
If you’re purchasing cannabis products for medical purposes, label accuracy and quality control are factors to consider. Because medical marijuana isn’t FDA regulated, product labels may not match their true chemical makeup. It may be hard to know if you’re getting what you thought you paid for.
One study looked at 75 cannabis products in 3 different U.S. cities. The researchers found that over 80% of the products they evaluated were mislabeled. They either had more THC or CBD than what was on the label, or less than what was labeled. Another review of 5 studies found that cannabis product labels were inaccurate anywhere between 17% to 86% of the time.
The bottom line
Medicare doesn’t cover medical marijuana. And unless the federal government legalizes marijuana, it can’t be covered by Medicare.
Meanwhile, in states where medical marijuana is legal, some doctors choose to recommend it, even if they can’t prescribe it. A few FDA-approved, cannabis-based prescription medications may be covered by your Medicare Advantage or Part D prescription drug plan. But they’re only available for certain diagnoses.
DISCLAIMER: Keep in mind that cannabis is legal in some states for recreational and/or medicinal use, but not in others. Cannabis is still illegal under federal law. Before you use cannabis products, find out the laws in your state.
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References
Fertig, N. (2022). House passes marijuana legalization bill (again), but with no clear path forward. Politico.
Finnegan, J. (2019) Marijuana legalization leaves doctors wondering ‘what do we tell our patients?’ Fierce Healthcare.
Internal Revenue Service. (2022). Publication 502: Medical and dental expenses (including the health coverage tax credit).
Medicare Plans Patient Resource Center. (2022). 1 in 5 Medicare recipients use medical marijuana.
National Conference of State Legislatures. (2022). State medical cannabis laws.
National Institute on Drug Abuse. (2021). Is marijuana safe and effective as medicine? Cannabis (Marijuana) Research Report.
Oldfield, K., et al. (2020). A systematic review of the label accuracy of cannabinoid-based products in regulated markets: Is what’s on the label what’s in the product? Australasian Psychiatry.
United States Drug Enforcement Administration. (n.d.). Drug scheduling.
U.S. Department of Veterans Affairs. (2022). VA and marijuana – what veterans need to know.
Vandrey, R., et al. (2015). Cannabinoid dose and label accuracy in CBD edible medical cannabis products. Journal of the American Medical Association.
Keep in mind that cannabinoids are legal in some states for personal and/or medicinal use, but not in others. Certain cannabinoids are still illegal under federal law.
