Does Medicare Cover Medical Marijuana?
Everything You Need to Know About Medical Marijuana and Medicare’s coverage of It
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According to a 2020 study, there are an estimated 3.6 million state-legal medical marijuana patients. Medical marijuana has been approved by 37 U.S. States and more are legalizing it each year.
This might make you wonder whether Medicare will cover the cost of medical marijuana in your state.
In this article, we will discuss what medical marijuana is, the legalities surrounding it, where to get it, how much it costs, and if Medicare can help cover it.
What Is Medical Marijuana?
Medical marijuana, also known as medical cannabis, is cannabis and cannabinoids that are prescribed by doctors to help treat patients.
It isn't very different from the Cannabis sativa plant that people use recreationally.
What Are Cannabinoids?
Cannabinoid refers to every chemical substance, regardless of structure or origin, that joins the cannabinoid receptors of the body and brain and has similar effects to those produced by the Cannabis sativa plant.
Source: Unsplash
Marijuana comprises more than 100 different chemicals called cannabinoids that each have a different effect on the body. The most well-known cannabinoid is called tetrahydrocannabinol (THC).
What Is THC?
THC is the chemical in marijuana that makes people feel different after eating, drinking, or smoking it.
Even though both CBD and THC are cannabinoids found in marijuana are similar in what they help treat, the most important difference is that THC has psychoactive properties (which induces a high) while CBD does not.
Many people use the term "medical marijuana" when they talk about cannabinoid-derived products made either by separating one ingredient of the plant (like CBD) or by synthesizing those ingredients in a lab.
What is CBD?
Cannabidiol, or CBD for short, is another cannabinoid that many people use. However, it does not have the same effect on the brain or body as THC.
CBD is considered an effective anti-seizure medication, but further research is needed to determine its safety and additional benefits.
Source: Unsplash
Does Medicare Cover Medical Marijuana?
Original Medicare won't cover the cost of purchasing a medical marijuana card or buying medical marijuana at a dispensary, because it’s considered a Schedule I controlled substance.
What Is a Schedule I drug?
Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.
Some examples of Schedule I drugs include:
Heroin
Lysergic acid diethylamide (LSD)
Marijuana
Ecstasy
Quaaludes (Methaqualone)
Peyote (a small cactus)
Medicare Part C, also known as Medicare Advantage, is run by private health insurance companies and helps cover dental, vision, and some prescription drugs, —but not medical marijuana.
The same is true for Medicare Part D, which is also sold by private health insurance companies. However, Medicare Parts C and D can cover cannabinoid medications approved by the FDA.
What Is Medicare Advantage and Medicare Part D?
Medicare Advantage Plans, previously known as Part C plans, are health plans offered by insurance companies that have contracts with Medicare. These policies cover Part A, B, and D expenses, including costs for hospital care, prescription drug coverage, and doctor’s visits.
Medicare Part D Plans, also known as Prescription Drug Plans, cover self-administered prescription drugs. For example, medications for high blood pressure, pain tablets, and antidepressants.
Important: Even if your Part D or Medicare Advantage plan covers cannabinoid medications, you may still need to get permission from your doctor before you can get them.
There may be paperwork that your healthcare provider must fill out before you can get a prescription, so contact your insurance company in advance.
What Does Medical Marijuana Treat?
Medical marijuana has been recommended to ease symptoms like:
Nausea
Loss of appetite
Inflammation
Anxiety
Pain
Epileptic seizures
Muscle stiffness
Medical marijuana can also be used to relieve some symptoms of AIDS or cancer, such as pain, loss of appetite, and weight loss.
According to a 2020 study, using medical marijuana can decrease stiffness and ease the symptoms of multiple sclerosis (MS).
Ways to Use Medical Marijuana
There are many ways to administer medical marijuana, including:
Taking cannabidiol capsules.
Smoking it.
Inhaling it through a vaporizer that turns it into a mist.
Eating it, for example in a brownie or lollipop form.
Applying it directly to the skin (e.g. a lotion, spray, oil, or cream).
Placing a few drops of a liquid under your tongue.
It all depends on your preference and each method works differently in your body.
Smoking it or using a vaporizer will make you feel the effects very quickly. However, if you eat it, the effects take significantly longer. It can take between 1 and 2 hours for edible products to take effect.
Source: Unsplash
Is Medical Marijuana Legal in the U.S.?
In many states, even those where medical marijuana is not legal, CBD products are sold to reduce anxiety, improve relaxation, and ease pain.
Source: Unsplash
State Medical Marijuana Laws
In 2021, 36 states approved the sale and use of medical marijuana. Some of those states have also made it legal for people to use cannabis products recreationally.
In states where only medical marijuana is legal, you need to obtain a medical marijuana card before buying or using it.
How to Get a Medical Marijuana Card
You may need to follow various rules and steps to obtain your medical marijuana card in different states, but there are a few basic things you need to do:
Make an appointment with your doctor or nurse. Your doctor will approve a medical marijuana card if they think it could help you. It is likely that your doctor will give you a full physical exam and closely examine your medical history before this decision is made.
Renew your medical marijuana card every year. Most times, medical marijuana cards are registered in the state where you live. When you renew your card, you may require a follow-up visit to your doctor, among other things.
Your doctor can't give you marijuana products directly. Federal law states that doctors can't prescribe illegal drugs and cannabis. Instead, your doctor can only suggest that you use it.
To qualify for a medical marijuana card, you should:
Be 18 years of age or older or be a minor patient with parental consent.
Be diagnosed with a qualifying medical condition.
Have an official written certification from a physician.
How Much Does a Medical Marijuana Card Cost?
Your first medical marijuana cost will be the card. The cost of medical marijuana cards depends on several factors, like:
The state you live in.
The type of card you require.
If you are a new or renewing applicant.
The cards generally cost between $50 and $200 when you first apply. There may also be annual renewal fees.
In order to get a new medical marijuana card, you'll need to see your doctor and talk about whether you still need it for your health.
Four FDA-Approved Cannabinoid Medicines
To date, the FDA has not approved a marketing application for cannabis for the treatment of any disease or condition.
What Is the Food and Drug Administration (FDA)?
The FDA is responsible for protecting public health by ensuring the safety, benefit, and security of human and veterinary drugs, biological products, and medical devices.
It also ensures the safety of the United States’ food supply, cosmetics, and products that emit radiation.
The FDA has, however, approved one cannabis-derived drug product: Epidiolex (cannabidiol), and three synthetic cannabis-related drug products: Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone).
Dronabinol, the THC-based cannabinoid, is used to treat the side effects of nausea and vomiting from chemotherapy, and also to stimulate the appetite of AIDS patients.
These approved drug products are only available with a prescription from a licensed healthcare provider.
Epidiolex
Epidiolex is a brand-name prescription drug used to treat seizures caused by three conditions:
Lennox-Gastaut syndrome
Dravet syndrome
Tuberous sclerosis complex (TSC)
What Are These Conditions?
Lennox-Gastaut syndrome (LGS) is a severe condition characterized by recurrent seizures (epilepsy) that begin early in life.
Dravet syndrome, previously called severe myoclonic epilepsy of infancy (SMEI), is an epilepsy syndrome that begins in infancy or early childhood and can include a spectrum of symptoms ranging from mild to severe.
Tuberous sclerosis complex (TSC) is an uncommon genetic disorder that causes benign tumors to develop in many parts of the body.
Marinol and Syndros
Both Marinol and Syndros are synthetic forms of cannabis used to treat:
Loss of appetite that causes weight loss in people with AIDS.
Severe nausea and vomiting caused by chemotherapy. It is usually given after medicines that control nausea and vomiting have been tried without success.
Marinol is available in capsule form while Syndros is a liquid form of THC.
Syndros may be a better option for certain individuals with severe nausea that experience difficulty swallowing tablets or capsules.
However, Syndros does contain nearly 50% alcohol by volume.
Both products are fairly expensive but Marinol is available generically and is significantly cheaper than Syndros.
Cesamet
The active ingredient in Cesamet is nabilone, a synthetically derived chemical structure similar to THC.
Similar to Marinol and Syndros, it is used to treat nausea associated with chemotherapy and comes in capsule form, like Marinol.
How Much Does Medical Marijuana Cost?
If you are considering buying medical marijuana, find out beforehand if:
The visit to the dispensary will be covered.
There’s a copayment and, if so, how much it is.
You’ll need to pay the full bill out-of-pocket.
In certain states, if you have a medical marijuana card, you can get a discount on the cannabis products you buy. The discounts may even pay for the card if you use it often enough.
The FDA-approved cannabinoid-based medicines may also be covered by your Medicare Advantage plan or prescription drug plan at least partially.
According to their website, you can get a bottle of Epidiolex oral liquid (100 mg/mL) for about $974, depending on which pharmacy you visit.
How Do I Get Medical Marijuana?
Because the laws regarding medical marijuana differ from state to state, this affects the process of getting medical marijuana.
The process in most states is as follows:
Register for the program through your state’s Medical Marijuana Registry.
Have a physician certify that you suffer from one of the medical conditions that qualify for medical marijuana.
Pay for a medical marijuana ID card.
Get medical marijuana from an approved dispensary in your state.
Medical marijuana is sold at specific stores known as medical marijuana dispensaries. These dispensaries are run by experienced and knowledgeable budtenders who act as consultants for the customers.
What Is a Budtender?
A budtender is a staff member who works within a dispensary or store where medical or recreational cannabis is sold.
Their job is to offer suggestions to customers, answer questions, handle products, and showcase products on offer.
Ideally, budtenders should know about the medical uses of the plant and be aware of the newest strains to recommend the right products to their customers.
Where Can I Learn More about Medicare?
If you have Original Medicare and qualify for the use of cannabinoid medication, perhaps switching to a Medicare Advantage plan, prescription drug plan, or private insurer could be a better option for you.
If you want to learn more about Original Medicare, Medicare Advantage Plans, or anything Medicare-related, head to PolicyScout’s Medicare hub to compare your options and find the best plan in your area.
If you are looking for personalized guidance, send your questions to Help@PolicyScout.com or call us on 1-888-912-2132 to get personalized assistance from one of our skilled Medicare consultants.