Is Medical Marijuana Covered by Medicare?

Medicare is a federal health insurance program. As medical marijuana’s legal status evolves, many wonder if Medicare covers it. The answer involves understanding Medicare’s specific regulations regarding prescription drugs and the federal classification of cannabis.

Medicare’s Prescription Drug Coverage

Medicare provides prescription drug coverage primarily through Medicare Part D plans. These plans are offered by private insurance companies approved by Medicare. To be eligible for Part D, individuals must have Medicare Part A or Part B and reside within the plan’s service area. Part D plans help manage the costs of prescription drugs, and each plan maintains a list of covered medications known as a formulary.

For a medication to be included on a Part D formulary, it must typically be approved by the U.S. Food and Drug Administration (FDA) and prescribed by a licensed healthcare provider for a medically accepted use. Formularies organize drugs into tiers, with lower tiers generally having lower out-of-pocket costs for beneficiaries.

Federal Legality and Medicare Policy

A primary reason Medicare does not cover raw or plant-based medical marijuana stems from its federal legal status. Under the Controlled Substances Act (CSA), marijuana remains classified as a Schedule I controlled substance. This classification indicates that, at the federal level, cannabis is considered to have no currently accepted medical use and a high potential for misuse.

Medicare, as a federal program, must adhere strictly to federal laws and regulations. Therefore, it cannot provide coverage for substances that are federally illegal, regardless of individual state laws that may permit medical or recreational cannabis use. Furthermore, for a drug to be covered by Medicare, it generally requires FDA approval, and the FDA has not approved raw botanical marijuana as a safe and effective treatment for any medical condition.

How Patients Pay for Medical Marijuana

Given that Medicare does not cover medical marijuana, patients typically bear the full cost themselves. This means that purchases are made out-of-pocket at dispensaries or other authorized retail locations.

While some state-level programs or private insurance policies might offer limited coverage for medical cannabis, such instances are rare and depend heavily on specific state regulations and the terms of individual insurance plans. These limited coverage options are distinct from and unrelated to Medicare benefits. For example, health savings accounts (HSAs) cannot be used to pay for medical marijuana due to its federal illegality.

Related Medications and Coverage

It is important to distinguish between raw medical marijuana and FDA-approved prescription medications derived from cannabis or synthetic cannabinoids. The FDA has approved several pharmaceutical products that contain cannabinoids, and these can be covered by Medicare Part D if prescribed for an FDA-approved use and listed on a plan’s formulary.

Examples of such FDA-approved medications include Epidiolex (cannabidiol), which is approved for treating specific seizure disorders, and synthetic cannabinoid products like Marinol (dronabinol) and Syndros (dronabinol), used to manage nausea and vomiting associated with cancer chemotherapy and anorexia related to AIDS. These medications undergo the same rigorous FDA approval process as other drugs, ensuring their safety, efficacy, and consistent quality. Their coverage by Medicare Part D does not imply coverage for the cannabis plant itself, but rather for these specific, regulated pharmaceutical products. Epidiolex is typically found on Tier 5 (specialty drugs) of Medicare Part D formularies, which may involve higher cost-sharing. While some plans may cover Syndros, others generally do not.