The Drug Enforcement Administration (DEA) categorizes cannabis, also known as marijuana, as a Schedule I substance under the Controlled Substances Act. Medicare does not cover cannabis, although it may cover cannabinoid-based medications.
Individual states vary in the legalization of recreational or medical cannabis within state boundaries.
This article explores Medicare’s coverage of cannabis-based prescription medicine and cannabis-related medications. It also discusses the health conditions that these medications may alleviate, compares THC and CBD, and shows costs.
Is CBD legal? Hemp-derived CBD products with less than 0.3% THC are legal federally but still illegal under some state laws. Cannabis-derived CBD products, on the other hand, are illegal federally but legal under some state laws. Check local legislation, especially when traveling. Also, keep in mind that the Food and Drug Administration (FDA) have not approved nonprescription CBD products, which may be inaccurately labeled.
The Food and Drug Administration (FDA) has not approved cannabis as safe and effective for medical use. It is illegal in many states.
If a person lives in a state where marijuana is legal only for medical use, they must have a medical marijuana card (MMJ). Even if a person lives in a state where medical cannabis is legal, their doctor cannot prescribe it but may recommend its use.
Medicare does not cover medical cannabis or any drugs the federal government has declared illegal. However, in 2018 the FDA approved one cannabis-based prescription medicine and three cannabis-related medications, which Medicare cover:
- The epilepsy drug Epidiolex is a pure form of cannabidiol (CBD), one of the more than 120 active ingredients, or cannabinoids, found in cannabis. It treats some severe and rare forms of epilepsy.
- The anorexia drugs Cesamet, Marinol, and Syndros are synthetic drugs based on delta-9-tetrahydrocannabinol (THC), another active component of cannabis.
Research by the National Academies of Sciences, Engineering, and Medicine has provided conclusive evidence that cannabinoids or cannabis can help manage some health conditions. These include:
Moderate evidence shows cannabis may help with sleep issues, fibromyalgia, chronic pain, low appetite, and Tourette’s syndrome.
A simple way a person can think about the difference between THC and CBD is that THC changes how a person feels, while CBD does not. CBD does not produce the characteristic cannabis high that is typical of THC.
When a person uses medical cannabis, the effects vary depending on what the medication contains. For example, if the medication is CBD dominant, it will contain minimal THC, and a person will not feel high. On the other hand, a medication with more THC may result in a person experiencing a high.
How does cannabis work?
THC and CBD are two chemically similar active components in the Cannabis sativa plant. THC is an abbreviation of the chemical name delta-9-tetrahydrocannabinol and CBD is the shortened form of cannabidiol.
Medications based on the cannabis plant use the plant’s dried flowers, stem, leaves, and seeds.
The human body has hundreds, if not thousands, of cannabinoid receptors that interact with THC and CBD. For example, CBD may help a person \with anxiety, depression, or seizure disorders, while THC can relieve pain, increase appetite, or have a relaxing effect.
Cannabis laws are continually evolving, and states may vary in how they classify THC and CBD.
Medical cannabis, and related programs, are legal in 33 states, Guam, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands as of 2018. If a person lives in a state where marijuana is legal only for medical use, they must have a MMJ.
Each state sets its own rules surrounding the approval and issuance of MMJs. For example, in Washington, D.C., a person would need to take the following two steps:
- Make an appointment with their doctor, who may conduct a physical examination and review the person’s medical history. The doctor may confirm the person has a health condition that medical marijuana could help, and will give a signed recommendation.
- The person gives the signed recommendation and an application form to the state’s pharmacy board. When a person gets medical marijuana authorization, they can register with the Medical Marijuana Authorization Database to get their MMJ card.
The MMJ card typically lasts for 1 year. After this time, a person may need a follow-up visit to their doctor.
In general, Medicare does not cover medical cannabis. The exceptions are the FDA-approved epilepsy drug Epidiolex, and the anorexia drugs Cesamet, Marinol, and Syndros.
Apart from when a person receives a prescription for FDA-approved drugs, medical cannabis may incur some costs.
Costs vary between states, but may include the following:
- Out-of-pockets costs related to a health care visit, such as to a doctor’s office.
- The cost of the medication. Although a person may not have to pay sales tax on the medical cannabis purchase from a medically endorsed retail store, they will generally have to pay the cost of the medication. Costs may vary based on the type and amount.
- A fee for using the medical cannabis card when getting the medication. This may vary depending on the store policy. Some stores may provide the medication at no charge to a person on a limited income.
- Cost for the MMJ card, which a person will need to renew each year.
Medicare prescription drug plans may cover or partly cover the FDA- approved cannabis-based medications. People should check their Medicare plan’s drug list before filling a prescription to determine if Medicare covers the cost.
Cannabis is a federally illegal drug. However, medical cannabis and related programs are legal in more than 30 states. Medicare does not cover the cost of medical cannabis but may cover some costs for some cannabis-based or associated medications.
A person who feels that medical cannabis may help with a medical condition can talk with their doctor. Depending on the state where a person lives, medical cannabis may be an option to relieve some symptoms.
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