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Medical marijuana is currently not covered by health insurance, including Medicare and Medicaid, due to its federally illegal status. However, there are ongoing discussions and efforts to include it in insurance coverage. In states where medical marijuana is legal, some doctors recommend it, and a few FDA-approved, cannabinoid-based prescription medications may be covered by Medicare Advantage or Part D plans for specific diagnoses. The changing legal landscape and potential benefits of medical marijuana, such as reduced reliance on prescription drugs and lower health insurance costs, are factors that could influence future insurance coverage decisions.
| Characteristics | Values |
|---|---|
| Does health insurance cover medical marijuana? | No, health insurance does not cover medical marijuana. |
| Why don't insurance companies cover medical marijuana? | Marijuana is classified as a Schedule I drug, making it illegal on a federal level. Insurance companies do not cover illegal substances. |
| Are there any exceptions? | In some cases, cannabinoid medications that have been approved by the FDA and are available without restriction may be covered by Medicare Part C and D. Synthetic versions of THC, such as Cesamet, Marinol, and Syndros, may be available via prescription for cancer patients and those undergoing chemotherapy or suffering from cachexia due to AIDS/HIV. |
| Are there any alternatives to insurance coverage for medical marijuana? | Some states offer reimbursement for the costs involved in obtaining a doctor's recommendation or certification for medical marijuana. Additionally, some dispensaries offer loyalty programs that provide discounts on medical marijuana purchases. |
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What You'll Learn
Medicare Part D coverage
Medicare Part D is medical insurance offered through private companies that covers prescription drugs. However, it does not cover medical cannabis. This is because cannabis is federally illegal and is not approved by the FDA.
Medicare Part D may cover cannabinoid-based medications that have been approved by the FDA and are available without restriction. These include medications like dronabinol (Marinol, Syndros), nabilone (Cesamet), and Epidiolex. If you have a prescription for cannabinoid medications, you can check your plan's list of covered medications, called a formulary, to see if they are covered.
If you are unsure about what your plan covers, you can contact your Medicare prescription drug plan directly. They can help you understand whether you have coverage for any cannabinoid medication and how to fill a prescription.
You must obtain a medical cannabis card before buying cannabis products, even in states where it is available recreationally. A medical cannabis card may provide discounts.
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Health insurance costs in legal states
The legalization of medical marijuana has been a topic of interest for many states in the US. While medical marijuana has been legalized in 33 states and Washington, D.C., it is still classified as a Schedule I substance at the federal level, making it illegal. This classification has implications for health insurance coverage and costs in states where it has been legalized.
In states where medical marijuana is legal, research has found that health insurance premiums are significantly lower. A study published in the International Journal of Drug Policy reported that seven years after the legalization of medical cannabis, annual premiums were $1,663 lower compared to states where it remained prohibited. This reduction in premiums persisted in the following years, with an $1,542 decrease in premiums eight years after legalization and a $1,626 decrease nine years post-legalization. These savings are not only beneficial to cannabis users but also to non-users, as insurance pooling and community rating result in lower premiums for everyone in the state.
The decrease in health insurance premiums can be attributed to several factors. Firstly, people in states with legal access to marijuana are less reliant on regular healthcare. They may opt for using legal marijuana as an alternative to prescription medications, reducing their overall healthcare expenses. Additionally, individuals in these states tend to be more open to alternative forms of medication, which are often not covered by insurance. This shift towards alternative treatments can lead to reduced healthcare costs and, consequently, lower insurance premiums over time.
The impact of medical marijuana legalization on insurance costs is also evident when comparing states with and without medical cannabis laws (MCLs). Studies have found that states with MCLs experience a statistically significant reduction in individual market health insurance premiums. This decrease in premiums is advantageous for both medicinal cannabis users and non-users, as the pooled nature of insurance results in shared savings.
While the legalization of medical marijuana has led to reduced health insurance premiums, it is important to note that health insurance typically does not cover the cost of medical cannabis. Marijuana is not included in the list of medications approved by insurance companies due to its federal classification as a Schedule I drug. Even if it were to be reclassified as a Schedule II or III drug, it would still require approval from the Food and Drug Administration (FDA), a process that usually takes years. Therefore, individuals seeking to use medical marijuana to manage their health conditions should not expect their health insurance plans to cover the associated costs.
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Flexible spending accounts
While flexible spending accounts (FSAs) allow people to pay for medical treatments, services, and products that their health insurance plans do not cover, they cannot be used to buy medical marijuana. This is because marijuana is federally illegal, and FSAs cannot be used to purchase illegal substances.
Even if marijuana were to be reclassified as a Schedule II or III drug or removed from the list of controlled substances, it would still likely not be covered by insurance companies for some time. This is because it would require Food and Drug Administration (FDA) approval, which usually takes years, and the process of getting new drugs approved is costly.
However, there are some cannabinoid medications that may be covered by Medicare drug plans for their intended uses because they are approved by the FDA. These include Cesamet, Marinol, and Syndros prescriptions. Additionally, FSAs may be used to pay for doctor visits related to your medical marijuana recommendation or use.
If you are unsure what your plan covers, you can check your plan's list of covered medications, called a formulary, or contact your plan directly to ask about coverage.
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Health savings accounts
Even if marijuana were to be reclassified as a Schedule II or III drug, or removed from the list of controlled substances, it would likely still not be covered by insurance companies for some time. This is because it would require Food and Drug Administration (FDA) approval, which usually takes years, and the process of getting new drugs approved is costly.
While HSAs cannot be used to purchase marijuana, they can be used to pay for doctor visits relating to medical marijuana recommendations or use. Additionally, if marijuana is reclassified and sold as an over-the-counter (OTC) drug, it may be eligible to be paid for using an HSA.
In states where marijuana is illegal, people shop for health insurance at twice the rate of people in legalized states. Research shows that some health insurance costs are lower in states with legal cannabis. This may be because people who have legal access to marijuana are less reliant on regular healthcare and prescription drugs.
Some insurance companies do cover the cost of cannabinoid-based medications and FDA-approved drugs containing synthetic weed.
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Insurance reimbursement
In the United States, medical marijuana is not classified as a prescription drug, and insurance companies do not cover it. This is because marijuana is classified as a Schedule I drug under federal law, making it illegal. Insurance companies will not pay for illegal substances, even if they are recommended by a doctor. Even in states where medical marijuana is legal, doctors can only issue a recommendation for a medical marijuana card that is valid in state-approved dispensaries, rather than a prescription. Doctors risk losing their DEA registration if they prescribe it.
However, cannabinoid medications may be covered by Medicare drug plans for their intended uses because they are approved by the FDA. These include Cesamet, Marinol, and Syndros, which are usually prescribed for cancer patients and those going through chemotherapy or cachexia due to AIDS/HIV. Additionally, some states offer reimbursement for the visit involved with receiving a doctor's recommendation or certification for medical marijuana. For example, New York offers Medicaid services reimbursement for patient evaluation and certification, though not for products.
Court cases in Pennsylvania and New Jersey have successfully argued for medical marijuana reimbursement in the case of workers' compensation. However, on a national level, Medicaid and Medicare will likely not assist with medical marijuana for several years. Most private health insurance plans also refuse to cover medical marijuana-related visits and services.
Even if marijuana is reclassified as a Schedule II or III drug or removed from the list of controlled substances, it is unlikely that insurance companies will cover it anytime soon. This is because it would still need to go through the lengthy and costly process of obtaining FDA approval.
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Frequently asked questions
No, insurance companies do not cover medical marijuana prescriptions, even in states where it is legal. This is because it is classified as a Schedule I substance on a federal level, making it illegal.
Insurance companies do not cover medical marijuana prescriptions because they require FDA approval. The approval process is costly and time-consuming, and marijuana is still considered a Schedule I drug with no recognised medicinal use.
Yes, cannabinoid medications with FDA approval are covered by some insurance plans. These include Cesamet, Marinol, and Syndros, which are synthetic versions of THC.
Yes, some dispensaries offer loyalty programs that provide discounts on medical marijuana. Additionally, some states offer reimbursement for doctor's visits related to medical marijuana recommendations.
