Medicare helps pay for the cost of many pain management options, such as physical therapy and medications. Depending on the type of treatment, coverage may come from different Medicare parts.
Many people in the United States live with chronic pain. Not only does this cause discomfort, but in some cases, it can limit a person’s activities.
Original Medicare, Medicare Advantage, and prescription drug plans all cover pain management. However, which benefit the coverage falls under will depend on how the treatment is given or administered.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to the Centers for Disease Control and Prevention (CDC), in 2021, an estimated
Medicare can help pay for pain management in the following ways:
Medicare Part A
Part A pays for inpatient hospital, hospice, and skilled nursing facility care.
If prescription medications manage a person’s pain while they are an inpatient in a hospital or hospice, Part A will cover eligible costs.
Some hospice care may require an individual to pay a $5 copayment for pain medication.
Medicare Part B
Part B helps pay for outpatient services, such as those to diagnose and treat medical conditions, as well as preventive care.
Part B can help cover monthly services for those living with chronic pain, including:
- acupuncture
- screenings and counseling for alcohol use disorder
- behavioral health integration services
- chiropractic services for subluxation
- depression screening
- individual and group therapy
- medication adjustments
- occupational therapy
- physical therapy
In some instances, Part B may cover prescribed drugs, such as when a doctor administers the medication in their office.
Medicare Advantage (Medicare Part C)
Private insurance companies administer Medicare Part C plans, also called Medicare Advantage.
These plans combine the benefits of parts A and B and often include additional benefits, which may include extra pain management services.
A person can check with their plan provider to explore the coverage options available to them.
Medicare Part D (prescription drug plans)
Private insurance companies also administer Part D prescription drug plans.
Part D will typically cover some form of pain medication, such as prescription opioids and plans often include Medication Therapy Management (MTM).
General 2025 out-of-pocket costs may include:
- Part A annual deductible of $1,676
- Part B deductible of $257
- standard Part B monthly premium of $185
- Part B coinsurance, which is usually 20% of eligible costs
- Part D premium, if a person has a prescription drug plan
Out-of-pocket expenses for pain management may vary depending on the type of therapy, and the person’s Medicare plan.
Without Part D, a person would likely pay for all prescription drugs themselves.
Medicare supplement insurance, also known as Medigap, can help cover some out-of-pocket expenses. Many different Medigap plans are available. However, if an individual turns 65 on or after January 1, 2020, Plan C and Plan F, which cover the Part B deductible, are no longer available. A person might be able to enroll for these plans if they were eligible before this time but did not enroll.
Medicare Part D plans have lists of covered drugs called formularies. Each plan can have a different formulary that may limit the kind of pain medication a person’s doctor can order.
If a doctor recommends a specific drug that is not listed on a plan formulary, a person may request an exception, and Medicare may review their coverage decision.
Medicare may limit some services for pain management, including chiropractic care, acupuncture, and physical therapy.
A doctor may order different therapies to help manage chronic pain. The type ordered will depend on the cause of the pain. Doctors may recommend treatment including:
- Acupuncture: Research suggests that this form of traditional Chinese medicine
may help with lower back pain. Part B covers up to 12 visits in 90 days for lower back pain. - Alcohol use disorder screening and counseling: Alcohol use can increase with chronic pain and may lead to different health conditions. Part B covers one screening and up to four brief counseling sessions each year.
- Chiropractic services: Data suggest chiropractic care may be
as effective as physical therapy to treat spinal pain. Part B covers chiropractic care to correct subluxation only. No other tests or services are covered. - Depression screening: Chronic pain can trigger depression, and depression can make pain worse. Part B covers yearly screenings with doctors who can order treatment or give mental health referrals.
- Medication: Doctors may order prescription medications or over-the-counter drugs to help control pain. Part D may cover some helpful drugs, including opioids, antidepressants, or seizure medications.
- Medication therapy management (MTM): This Part D program is for people with complex needs. Its aim is to ensure a person’s drugs are working as hoped and to manage costs.
- Occupational therapy: Part B covers this service with a 20% coinsurance after the Part B deductible. A therapist evaluates how pain limits a person’s activities. They help individuals with durable medical equipment or strategies to manage pain.
- Physical therapy: Used to improve strength or correct how a person uses their body, physical therapy can change and improve posture and reduce pain. Coverage comes from Part B and is subject to 20% coinsurance and the Part B deductible.
Medicare covers pain management, but the type of service or treatment will determine how it is covered.
Pain management delivered at a hospital is normally covered under Part A. Part B pays for outpatient services, such as acupuncture, screenings, and physical and occupational therapy.
Medicare Advantage comprises parts A and B, often includes prescription drug coverage, and may also provide extra benefits, including pain management services.
Part D covers prescription drugs and often includes Medication Therapy Management for those with complex needs.
Medigap plans can help people with Original Medicare pay out-of-pocket costs, including deductibles, copayments, and coinsurance.