Laws regarding marijuana use are changing at a rapid pace: As of the beginning of 2020, 33 states have legalized marijuana for medical use. Depending on where you live, your doctor may be able to prescribe it to you if you’re suffering from symptoms such as nausea, pain, loss of appetite, or anxiety. However, if you’re on Medicare, you should know before you get to the dispensary that your insurance won’t pay for this particular prescription. Medicare covers a myriad of health services and treatments, but medical marijuana isn’t one of them. Hence, let’s discuss the subject of Medicare and marijuana.
Does Insurance Cover Medical Marijuana in States Where It’s Legal?
The quick answer is no, insurance companies don’t cover medical marijuana prescriptions, even if they’re legal in your state. There are two questions insurance companies ask before determining whether to add a prescription medication to its formulary. A formulary is the list of medications that an insurance plan provides coverage for, and many factors can be used to decide which prescriptions are cut. For a new treatment to even be considered for approval, the answer typically needs to be “yes” to both of the following questions:
- Is it legal?
- Is it approved for medical use by the Food and Drug Administration (FDA)?
In the case of medical marijuana, the answer to those questions is “no.” Despite individual states legalizing medical marijuana, marijuana is illegal at a federal level and is classified by the Drug Enforcement Administration (DEA) as a Schedule I drug. Schedule I drugs aren’t approved for any kind of medical or recreational use. In addition to the DEA’s classification, the FDA hasn’t endorsed marijuana as having medicinal value.
Insurance plans don’t cover services or treatments that are illegal, and they rarely cover treatments that haven’t been authorized by the FDA. Because of these factors, insurance plans don’t pay for medical marijuana. To receive your prescription, you’ll have to pay out-of-pocket for the full cost.
Does Medicare Cover Prescriptions Derive from Medical Marijuana?
Yes, your prescription plan may cover a medication that’s derived from marijuana, even though it won’t cover medical marijuana itself. Four FDA-approved prescriptions contain compounds that are also found in marijuana.
1. Marinol and Syndros
Marinol and Syndros are both brand-name medications that contain an active ingredient called dronabinol. Dronabinol is a synthetic version of a compound found in marijuana, and it’s typically prescribed to treat the side effects of chemotherapy in cancer patients such as nausea and vomiting.
2. Cesamet
Cesamet is from Nabilone, another synthetic compound that you can base on one in marijuana. Doctors prescribe to help manage nausea and vomiting that can occur from chemotherapy.
3. Epidiolex
This is currently the only medication that contains an ingredient directly from marijuana the FDA. Epidiolex contains cannabidiol (CBD), and it’s used to reduce seizures in people who have Dravet syndrome or Lennox- Gastaut syndrome.
Marinol, Syndros, Cesamet, and Epidiolex can be prescribed in all 50 states. You would fill your prescription at a pharmacy, rather than a dispensary, and your insurance plan may pay for them. Each prescription plan can have its formulary, so you’ll need to check with your plan to learn which ones are covered.
Does Medicare Cover CBD Oil?
Cannabidiol (CBD) isn’t only known as the active ingredient in Epidiolex; it’s becoming increasingly popular with people who want the purported medicinal benefits of medical marijuana without the high. CBD can be extracted from hemp, which is a legal version of marijuana. You can find it in products ranging from beauty care to nutritional supplements.
While you may be able to find products that contain CBD easily in the store, its legal status is currently a gray area. Federal and state laws vary on issues such as who can produce, buy, or sell it. The Food and Drug Administration hasn’t approved CBD for medicinal purposes outside of its use in the drug. Because of this, apart from this drug, Medicare doesn’t cover CBD oil or CBD products.
Can one use Health Savings Account or Flexible Spending Account to Pay for Medical Marijuana?
You can use the money in your Health Savings Account (HSA) or Flexible Spending Account (FSA) on numerous health-related costs that insurance doesn’t cover, such as copays and over-the-counter medicine. However, for your HSA or FSA to pay for an item, it must be on a list of qualified expenses. Medical marijuana isn’t federally legal, so it can’t be included in this list. You’ll need to pay out-of-pocket for your prescription, and you can’t be reimbursed by your HSA or FSA.
State Medical Marijuana Laws
As of 2021, 38 states and the District of Columbia have approved comprehensive, publicly available medical marijuana programs.
Fifteen states and the District of Columbia have also approved recreational marijuana use for adults.
In states where only medical marijuana is legal, you must get a medical marijuana card to purchase the drug.
The process for obtaining a medical marijuana card varies by state.
However, a few basic rules apply.
As with any prescribed medication, you need a reason for a doctor to recommend medical marijuana. Each state has its list of ailments that you can legally treat with cannabis, such as pain, PTSD, or cancer.
Next, you will need to ask your doctor if he or she is comfortable issuing you a medical marijuana card. You can also look online for medical professionals who register with your state’s cannabis program.
Some states require you to sign up with the state-maintained registry of medical marijuana patients. In other states, this step is optional.
Finally, after you’ve received your medical marijuana card from medicare, you will need to locate a nearby dispensary to purchase the product.
Conclusion
In general, all insurances, including Medicare, don’t cover medical marijuana. Your insurance may cover one of the FDA-approved medications that contain compounds. It is based on or derived from marijuana. Also depending on the prescription drug plan that you have. If you live in a state where medical marijuana is legal, prepare to pay the full cost of your prescription. You can consult with your doctor for more information on what treatments are available to you.
You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as before undertaking any specific exercise or dietary routine.
