Paul Sanchez
Medical marijuana is not covered by health insurance in the United States due to its classification as a Schedule I drug at the federal level. This classification means that marijuana is considered a controlled substance, and it is illegal for healthcare providers to prescribe it. In some states, healthcare providers can recommend it or refer patients to a state dispensary, but insurance will not cover the cost. In Canada, medical marijuana coverage became available as a stand-alone option for those who qualify under Medavie Blue Cross' Extended Health Care in 2018.
Is Medical Marijuana Covered by Health Insurance?
| Characteristics | Values |
|---|---|
| Federal Law | Marijuana is illegal under federal law and is classified as a Schedule I drug. |
| State Law | Marijuana is legal for medical use in 38 US states and Washington, D.C. |
| Insurance Coverage | Health insurance providers do not cover the cost of medical marijuana due to its federally illegal status. |
| Medicaid | Does not cover medical marijuana but may cover cannabinoid medications like Epidiolex and Syndros that have been approved by the FDA. |
| Medicare | Does not cover medical marijuana but may cover cannabinoid-based medications. |
| Canada | Medical marijuana coverage is available as a stand-alone option under Medavie Blue Cross' Extended Health Care for those who qualify. |
| New Mexico | A federal court in New Mexico ruled that health plans from Blue Cross & Blue Shield of New Mexico are not required to pay for medical marijuana to treat behavioral health conditions. |
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What You'll Learn
- In the US, medical marijuana is not covered by Medicare
- In Canada, medical marijuana coverage is available as a stand-alone option
- In the US, cannabinoid medications may be covered by Medicare drug plans
- In the US, medical marijuana is illegal at the federal level
- In the US, medical marijuana is legal in 38 states
In the US, medical marijuana is not covered by Medicare
While Medicare Part C and Part D plans can provide additional coverage beyond Original Medicare, they do not cover medical cannabis. However, they may cover the cost of cannabinoid medications that have been approved by the FDA and are available without restriction. These medications include Epidiolex, a CBD product, and three synthetic THC products: Syndros, Marinol, and Cesamet.
In states where medical marijuana is legal, healthcare providers can recommend it or refer patients to a state dispensary. However, patients are typically responsible for the full cost of medical cannabis, and it is not covered by insurance. This is the case even in states like Florida, which recognizes marijuana as medicine in its constitution. While some insurance companies operate exclusively within these states, they still do not cover medical marijuana due to its federal classification.
It is important to note that the landscape surrounding medical marijuana and insurance coverage is evolving. For instance, in Canada, medical marijuana coverage became available as a stand-alone option under Medavie Blue Cross' Extended Health Care in 2018. Additionally, legislative sponsors of a New Mexico insurance bill had indicated that it would include coverage of medical marijuana, although a federal court in the state later dismissed a lawsuit seeking to require Blue Cross & Blue Shield of New Mexico to cover it.
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In Canada, medical marijuana coverage is available as a stand-alone option
In Canada, the use of marijuana for medicinal purposes has been legal since 2018. However, the coverage of medical marijuana by health insurance plans remains complex and evolving. The availability of coverage depends on several factors, including the insurance provider, the policy terms and type, and the medical condition being treated.
Some insurance companies in Canada do cover the cost of medical marijuana as a stand-alone option. For example, Medavie Blue Cross offers medical marijuana coverage under its Extended Health Care plan. This coverage is provided as a reimbursement benefit for fresh and dried cannabis and cannabis oil. It is important to note that other cannabis products and consumption-related products are not eligible for reimbursement under this plan. To qualify for reimbursement, individuals must be pre-authorized and receiving medical cannabis under the Access to Cannabis for Medical Purposes Regulations (ACMPR).
Another example is Sun Life, which became the first major health insurer in Canada to cover medical cannabis in early 2018. Individuals with Sun Life insurance can check with their representative or employer to see if their health plan includes medical cannabis coverage.
In addition to these insurance companies, it is worth noting that Veterans Affairs Canada provides coverage for veterans with specific conditions who meet certain eligibility criteria. Furthermore, some disability policies offer coverage for individuals living with disabilities.
When considering insurance coverage for medical marijuana, it is essential to carefully review the terms and conditions of the policy. It is also recommended to consult with a healthcare practitioner to determine if marijuana is an appropriate treatment option for your specific condition. By obtaining the necessary documentation and understanding the coverage options, individuals can make informed decisions about their treatment and insurance choices.
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In the US, cannabinoid medications may be covered by Medicare drug plans
In the United States, the use of medical marijuana is legal in 38 states and the District of Columbia. However, its federally illegal status makes it impossible for health insurance providers to cover the cost of medicine. Medicare, for instance, does not cover the cost of medical cannabis because it is federally illegal and not approved by the FDA.
Despite Medicare not covering medical cannabis, cannabinoid medications may be covered by Medicare drug plans for their intended uses because they are approved by the FDA. These include Dronabinol (Marinol, Syndros), Nabilone (Cesamet), and Epidiolex. Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under certain conditions. Medicare Part D, which covers prescription drugs, does not include medical cannabis. However, it may cover cannabinoid medications that have been approved by the FDA and are available without restriction.
It is important to note that Medicare drug plans can make changes to their drug list during the year when drug therapies change, new drugs are released, or new medical information becomes available. If you are unsure what your plan covers, you can contact your Medicare prescription drug plan directly to understand whether you have coverage for any cannabinoid medication and how to fill a prescription.
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In the US, medical marijuana is illegal at the federal level
In the US, cannabis is classified as a Schedule I drug under the Controlled Substances Act, which means it is deemed to have a high potential for abuse and no accepted medical use. This classification makes the distribution of cannabis a federal offence.
Despite the fact that cannabis is now legal for medical use in the majority of US states, its federally illegal status makes it impossible for health insurance providers to cover the cost of medicine. The AARP has stated that Medicare will not cover medical marijuana, and the Kentucky Office of Medical Cannabis has said it is unaware of any insurance that will.
The issue is not solely due to the federal government's classification of marijuana as a Schedule I drug. For insurance companies to cover medical marijuana, they would have to add cannabis to the list of medications approved for its members, known as a drug formulary. Even if marijuana were 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 is a lengthy process, and the involvement of "Big Pharma", which will drive up costs.
In 2018, the United States Health and Human Services Secretary, Alex Azar, responded to a question about medical marijuana's role in providing pain relief as an alternative to opioids. He said:
> "We very much want to get away from the opioids, and we very much want to get people into treatment and recovery, but we want to do that through the FDA process, where we know it's safe and effective, and we know that it's actually helping to keep people away from the opioids."
In 2020, the US House of Representatives voted in favour of the MORE Act, which would have ended the federal prohibition of cannabis by removing it from the Controlled Substances Act and ending criminal penalties. However, the bill did not advance in the Senate.
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In the US, medical marijuana is legal in 38 states
The classification of cannabis as a Schedule I drug was first challenged in 1972 by the National Organization for the Reform of Marijuana Laws (NORML) in a petition to the Bureau of Narcotics and Dangerous Drugs. After a decade of legal battles, public hearings were held in 1986, and in 1988, DEA Chief Administrative Law Judge Francis L. Young ruled in favor of moving cannabis to a Schedule II classification. Despite this, cannabis remains a Schedule I drug under the Controlled Substances Act, prohibiting its use for any purpose.
At the state level, the legalization of medical marijuana has been achieved through ballot measures and state legislature. Ballot measures have been used in states such as Montana, Michigan, Arizona, Massachusetts, Arkansas, and Florida, among others. State legislatures have legalized medical marijuana in states like Vermont, Rhode Island, New Mexico, New Jersey, Delaware, and Connecticut.
Despite the legality of medical marijuana in many states, health insurance providers do not cover the cost of medicine due to its federally illegal status. The Affordable Care Act (ACA) also does not provide coverage beyond the boundaries set by the DEA. Medicaid, which offers comprehensive healthcare coverage to over 85 million low-income individuals, does not include monthly medical cannabis costs in its plan. Similarly, Medicare, a federal health insurance program for people aged 65 and over and those with specific disabilities, does not cover medical marijuana.
While health insurance does not cover medical marijuana, some states, like Florida, have recognized its medicinal value and registered more than 200,000 patients as medical marijuana patients. Medical cannabis is used to treat a wide range of conditions, including cancer, anorexia, AIDS, chronic pain, glaucoma, and arthritis. Senate Bill 8A in Florida also allows for the treatment of other "diagnosable, debilitating conditions" such as anxiety, depression, and migraines.
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Frequently asked questions
No, medical marijuana is not covered by insurance in the US. Marijuana is still a Schedule I drug at the federal level, which means insurance companies cannot cover it.
Even in states where medical marijuana is legal, insurance companies are not required to cover it. This is because marijuana is still illegal under federal law.
In Canada, medical marijuana coverage became available as a stand-alone coverage option for those who qualify under Medavie Blue Cross’s Extended Health Care in 2018.
