When does Medicare cover medical marijuana?

Many older adults use medical marijuana to treat a variety of conditions, but experts say conflicting laws, unclear safety standards and complicated regulatory processes mean it could take years for Medicare to cover the drug.

One in five Medicare beneficiaries currently use medical marijuana, according to an April 2022 poll from the Medicare Plans Patient Resource Center, an organization that provides Medicare guidance and information. And almost a quarter have used it in the past. Two-thirds of Medicare beneficiaries think Medicare should cover it, the poll found.

But Medicare does not cover medical marijuana because it is not federally legal and not approved by the Food and Drug Administration. Here’s where the situation stands.


In an analysis of data from a large cannabis dispensary in New York, 60% of patients were 50 or older, according to an April 2022 article in the journal Cannabis and Cannabinoid Research. The patients used cannabis for, among other things, severe or chronic pain, cancer, Parkinson’s disease and neuropathy.

And marijuana isn’t cheap: Patients may pay as much as $5 per dose for edibles or $5 to $20 per gram for plant buds, according to New York Cancer & Blood Specialists, which provides care for patients with cancer and blood disorders. (That’s about $142 to $567 per ounce.) Even in states where medical marijuana can be legally prescribed, patients may not be able to afford the prescription.

“This medicine is so expensive,” said Debbie Churgai, executive director of Americans for Safe Access, a nonprofit dedicated to ensuring safe and legal access to cannabis for therapeutic use and research. “There are some states now where insurance will cover the cost of the doctor’s visit or the cost of the marijuana card, but no insurance will cover the cost of the actual products.”


Two significant issues stand between medical marijuana and Medicare coverage. The first is that the government classifies marijuana as a Schedule I drug, a category of drugs with “no currently accepted medical use and a high potential for abuse” in the United States, according to the Drug Enforcement Administration.

“There’s no way the federal government is going to reimburse people through a federal program for a drug they consider illegal,” said Paul Armentano, deputy director of NORML, the National Association for Reform of Marihuana Laws.

The other problem is that Medicare requires the FDA to approve a covered drug as safe and effective. Although the FDA has approved one cannabis-derived drug and three synthetic cannabis-related drugs for prescription use, the agency has not approved the marketing of cannabis for medical treatment.


Sure, marijuana is illegal at the federal level, but medical marijuana is now legal in 37 states and Washington DC. Could private insurers—firms that offer Medicare Advantage, for example—decide to cover it?

Not likely, says Kyle Jaeger, a cannabis policy reporter and senior editor at Marijuana Moment, a cannabis news site. Like banking institutions that have been hesitant to offer services to marijuana companies, major health insurance companies are likely to decline to cover cannabis as long as it remains a Schedule I drug under federal law.

Private insurers also rely on the FDA to guide them on which drugs to cover. Consider that the FDA released a statement in January saying that current regulatory pathways are insufficient to allow the agency to classify CBD as a dietary supplement.

“It’s incredibly frustrating for consumers because all they want is a safe, consistent product,” says Jaeger.


Among other things, the marketplace needs more data on the medical use of cannabis. “(Insurers) need data to show that outcomes from cannabis treatment are equivalent to, if not better than, existing options that they cover,” says Dr. Benjamin Caplan, founder and chief physician of the CED Clinic, which provides services to individuals seeking cannabis treatment.

This is complicated in part by the free market dispensing system, where patients are free to purchase any product. “The system needs to be adjusted,” says Caplan. “Patients can’t just have carte blanche to buy whatever they want and the insurance companies are on the hook to cover it.”

Given the breadth of legal and regulatory hurdles the process faces, plus an overhaul of the dispensing system, the road to cannabis coverage is long, Jaeger says. “I would say we’re years away from having that conversation and regulations for something like Medicare.”

This article was provided to The Associated Press by the personal finance site NerdWallet. Kate Ashford is a writer at NerdWallet.

When does Medicare cover medical marijuana?

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