Does Health Insurance Cover Medical Marijuana?

Health insurance coverage for medical marijuana is a frequent concern for individuals seeking alternative treatment options. The complex legal landscape, marked by diverging federal and state laws, creates confusion regarding financial coverage. This article clarifies the general position of health insurance providers on medical marijuana expenses.

The Current Legal and Regulatory Landscape

Marijuana remains classified as a Schedule I controlled substance under the federal Controlled Substances Act (CSA), indicating it has a high potential for abuse and no currently accepted medical use in the United States. This federal classification means that, despite its legalization for medical use in numerous states, cannabis is still illegal at the federal level.

The U.S. Food and Drug Administration (FDA) has not approved botanical marijuana as a recognized medicine. The Schedule I classification creates significant hurdles for researchers to conduct the large-scale clinical trials required by the FDA.

This federal prohibition and absence of FDA approval are significant barriers for insurance companies. Insurers often adhere to federal guidelines, impacting whether medical marijuana can be covered by health insurance plans.

Health Insurance Coverage of Medical Marijuana

Health insurance plans, including private insurance, employer-sponsored plans, Medicare, and Medicaid, do not cover the cost of medical marijuana. This lack of coverage stems primarily from marijuana’s continued classification as a Schedule I controlled substance under federal law and the absence of FDA approval for its medical use. Insurance policies often contain “illegal acts” exclusions, meaning they will not cover health issues or treatments related to voluntary involvement in activities deemed illegal federally.

Medicare, a federal program for individuals over 65 and those with certain disabilities, strictly adheres to federal law. Therefore, Medicare does not cover medical cannabis because it is federally illegal and not approved by the FDA. Similarly, Medicaid, a joint federal-state program, also follows federal guidelines and does not cover medical marijuana costs.

Private health insurers largely mirror federal policy, as many operate on a national level and must comply with federal mandates. While some states have explored requiring insurers to cover medical cannabis, such initiatives are not widespread.

While medical marijuana itself is not covered, some FDA-approved cannabinoid-based medications may be covered by prescription drug plans, such as Medicare Part D or Medicare Advantage plans. These include synthetic THC drugs like dronabinol (Marinol, Syndros) for nausea and appetite loss, and nabilone (Cesamet) for chemotherapy-related nausea, as well as cannabidiol (Epidiolex) for specific seizure disorders. These specific medications have undergone the rigorous FDA approval process and are distinct from botanical medical marijuana.

Costs Not Covered by Insurance

Since health insurance typically does not cover medical marijuana, patients should anticipate incurring various out-of-pocket expenses. The initial step for many patients involves obtaining a medical marijuana recommendation or certification from a qualifying physician. The cost for a physician consultation can range from approximately $50 to $350, with some clinics charging around $100 to $300 for an initial visit.

Following the physician’s certification, patients usually need to register with their state’s medical marijuana program to receive a medical marijuana card. State registration or licensing fees for these cards can vary, typically ranging from $25 to $150 annually, with some states offering reduced fees for certain groups, such as those on assistance programs. These cards often require annual renewal, incurring recurring state fees.

The direct cost of purchasing medical cannabis products from dispensaries constitutes another significant expense. Prices vary widely based on product type (e.g., flower, concentrates, edibles), potency, and location. Patients might spend anywhere from $100 to $200 per month on medical marijuana, though costs can range from $275 per month or more for some individuals depending on usage and product choice. Health Savings Accounts (HSAs) also cannot be used to pay for medical marijuana, as the Internal Revenue Service (IRS) considers it an ineligible expense due to its federal status.