Q&A

Is Medical Marijuana Covered by Insurance?

Until medical marijuana is legalized at a federal level, health insurance in the US will struggle to cover this expense.

Health insurance doesn’t usually cover medical marijuana, resulting in patients having to buy it themselves. In ⅔ of the US, patients with certain health conditions can use medical marijuana for pain relief. But Medicare won’t cover medical marijuana unless the government legalizes it at the federal level. 

This gap between Federal and State law leaves patients with conditions such as cancer, epilepsy, and multiple sclerosis without coverage for medical marijuana. Therefore, patients who need medical marijuana need to pay from their pocket or buy painkillers.

Insurance can only cover some FDA-approved drugs like Epidiolex and synthetic weed versions like Marinol and Syndros.

Some states, like New York, allow insurance to cover the costs of evaluation and certification. But that doesn’t include the products. Still, most insurance companies don’t want to get into legal trouble with the Federal government, so they have illegal acts exclusion.

Is medical marijuana covered by medicare?

Even though 1 in 5 Medicare recipients currently use medical marijuana, Medicare doesn’t cover medical expenses. Medicare is a national health insurance organization under the wing of the federal government. Therefore, Medicare follows the FDA‘s decisions.

The FDA doesn’t approve Medical marijuana or any other drugs that are illegal, according to the federal government. Despite individual States recognizing the medical value of this plant, the FDA‘s ( Food and drug administration) stance on this one is clear – Marijuana is a schedule 1 drug.

Will Medicare cover medical marijuana in the future?

So far, Medicare does not provide coverage for patients who need medical marijuana. Medicare won’t cover the expenses until the federal government approves medical cannabis use. 

The first step is for the DEA to move marijuana from Schedule 1(i) to Schedule 2 ( ii) or 3 (iii) drug. If this happens, there is a long journey ahead to get the federal government‘s approval.

Medicaid

Medicaid is a health insurance organization operated by the federal government. The difference between Medicare and Medicaid is that the latter helps patients with low incomes. More precisely, Medicaid helps them access the best and most affordable health plans.

Still, the same rules apply to all organizations under the federal government. Consequently, even low-income patients don’t have their expenses covered.

Some states offer reimbursement through Medicaid for evaluation and certification, but that doesn’t include products.

Will Medicaid cover medical marijuana expenses in the future?

Just like with Medicare, until the federal government changes its decision, it is unlikely that this organization will cover the costs. However, a possible solution for low-income patients can be patient relief programs and dispensaries that offer discounts.

What about private health insurance plans?

Even though private health insurance isn’t like public insurance, they don’t cover costs related to medical marijuana. The reason behind the decision is that private health insurance companies still have to comply with the same coverage requirements. 

Therefore, if you have private health insurance, it won’t cover marijuana-related appointments and purchases.

In addition, it is improbable that private health insurance will cover the costs before public companies do. They are all in the same boat, and if change happens, it will affect all of them at the same time. 

The change will initiate higher rates, which can mean a lot of money for private health insurance plans. For example, an individual now pays approximately $7,739 per year for private health insurance, so the price can go to $10,000 with medical marijuana expenses.

Why doesn’t insurance cover medical marijuana?

The road to insurance covering medical marijuana expenses is long and complicated. First of all, medical marijuana is federally illegal. Most insurance companies have an “illegal acts exclusion,” which means they don’t take responsibility for involvement with illegal substances.

Why is medical marijuana federally illegal?

The federal government claims marijuana is a schedule 1 drug, implying that it doesn’t have medical value for patients.

Even though most states have legalized medical marijuana, only doctors with a DEA number can prescribe it. As long as it’s like that, many doctors don’t want to for numerous reasons and just recommend it.

Even if they change it to a Schedule 2, or 3 drug ( allowing prescriptions and decriminalizing it), the situation won’t change soon. The whole process looks like this:

To cover the costs of medical marijuana, insurance companies have to add it to the drug formulary, which won’t happen unless the FDA approves it. Getting approval is hard because there need to be many clinical studies that are expensive and difficult to conduct. Even if the FDA approves, big pharma will get exclusive marketing rights, leading to higher costs.

Eventually, some insurance companies may add it as a prescription drug to the formulary, but it would take years. Plus, adding it may result in higher patient insurance rates, which many of them find unacceptable.

Another possible solution would be classifying medical marijuana as an herbal remedy.

Herbal remedies are made from plants, and many use them in traditional medicine as cures for many diseases. The most famous herbal remedies Americans use are Echinacea and Andrographis.

There is no straightforward and fast solution to this problem. Getting to the point of insurance covering medical marijuana costs will take years.

Does having a medical card affect your health insurance?

Many patients know that their health insurance plan doesn’t cover medical marijuana, but does it influence the price of the health care plan? Generally, having a medical marijuana card and using these products for treatment doesn’t impact your insurance expenses.

The factors that influence your health insurance expenses are usually:

  • Age
  • Location
  • Tobacco use
  • Plan category
  • Individual vs. family enrolment

You are on the safe side regarding health insurance, but you may get higher rates for life insurance. Some life insurance companies put tobacco and medical marijuana users under the same category. This category has higher rates. Therefore, you may end up paying more than before starting your treatment.

Can you cover up that you have a medical marijuana card? Generally, the insurance company may ask for your medical records and may get this information easily. 

Is CBD covered by insurance?

No, your health insurance won’t cover your CBD-related purchases.

Insurance rarely covers supplements, and the Federal government considers CBD a supplement.

Therefore if you want to buy CBD products, you may have to shell out more than $100 straight from your pocket. Even though many researchers emphasize the division between marijuana and CBD products, health insurance companies don’t see it that way.

One exception is Epidolex (CBD-based) medication is covered because you can use it to treat some rare forms of Epilepsy. Your insurance will cover the costs if you are eligible to take this medication.

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