Medical Marijuana and Medicare

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The legalization of marijuana for medical and treatment purposes across several U.S. states has increased the discussion on its viability and safety. The issue remains controversial up to this day, especially as cannabis is listed by the Drug Enforcement Agency as a Schedule 1 drug, which means that it has a high potential for abuse and is seen to have no presently acceptable medical purpose for healing.

Studies on the effectiveness of consuming or inhaling cannabis are few and proof of their sustained positive effects are limited. Still, a growing number of senior citizens are turning to this alternative form of medicine to address a wide number of ageing related conditions and illnesses.

Medical Marijuana and Senior Citizens

According to the National Council for Aging Care, the number of senior citizens using medical marijuana has increased by a whopping 250 percent from 2006 to 2013. In a 2018 study conducted by physicians from the geriatric and palliative medicine at Northwell Health in New York, it was also revealed nine out of 10 seniors like using this product for addressing chronic pain and said they will recommend that their friends and loved ones take it as well.

Those who have used medical cannabis for treatment purposes present reasonable proof that it works, although because it is an herbal product, doctors caution that its effects may differ from person to person. Still, it has not stopped advocates of this treatment to promote it as reliable in terms of treating a wide number of child, adult, and senior health problems such as general pain, Alzheimer’s disease, mental health disorders and anxiety, eating disorders, sleep problems, neurological deficits, glaucoma, and more.

The Legalities of Medical Cannabis

Before moving forward to whether medical marijuana is qualified under Medicare coverage, we have to first understand the legal and state implications related to its use. First, it is classified as a Schedule 1 Drug, which means it is not generally accepted as safe for use. It is also not approved by the U.S. Food and Drug Administration, which is a primary prerequisite for qualifying for Medicare assistance. Although in some states, medical marijuana is considered acceptable and fully legal, it will first need the approval of the FDA for it to be classified as a true medical program.

Do note that for a drug or a treatment to obtain an FDA seal of approval, it will have to undergo clinical trials involving thousands of human subjects to determine the measurable benefits and true risks from its use. To date, there are no large-scale studies that will show the effectiveness of medical cannabis and prove that its benefits outweigh its risks and potential addictive issues.

Medical Marijuana and Medicare Assistance

So, does Medicare cover medical marijuana and its components? For now, it’s a big NO. If your doctor prescribes medical marijuana as part of your treatment program, even if you are in a state that declares it as legal, Medicare reserves the right to refuse shouldering its related expenses. Take note that you will first need a Medicare Part D policy to be able to seek subsidy or full coverage for prescription drugs, otherwise you will have to sign up for a Medicare Supplement (Medigap) to obtain assistance for medications.

Despite this snag, seniors who are supporters of medical marijuana shouldn’t lose hope just yet. This is because there are certain prescription drugs that may mimic the effects of cannabis, which then may be acceptable in Medicare or Medigap’s list of medications for coverage. It’s best that you speak with your healthcare provider to find the best options for care that will still be covered by your policy. Otherwise, be prepared to shoulder the out-of-pocket costs of incorporating medical cannabis to your maintenance or treatment program. If you have questions about the role of Medicare in the use of medical marijuana, talk to a qualified advisor who can help lay out all your choices before you make a decision. Medical cannabis is increasingly being accepted as a solid form of treatment for various types of illnesses. As its proponents launch more campaigns and conduct more research and studies about its effectiveness, it’s not really entirely impossible that Medicare and Medigap would also take it under their wings in the future.

Does Medicare Pay for Holistic or Alternative Medical Treatments?

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As we age, the less reliant people want to be on medications and instead seek ways to adopt a healthier way, holistic way of living. Alternative medicine has been the preferred option among many older adults in the U.S. to enhance their quality of life. Research has shown that seniors have turned to alternative modes of health care to feel better about themselves and to extend their years, with the likes of massage therapy, yoga, chiropractic care, acupuncture, and transcutaneous electrical nerve stimulation (TENS) exhibiting promising and enduring results.

With the enhanced role of holistic treatments in the improvement of senior citizens’ quality of life, it is only expected that Medicare programs would include them in their coverage. However, as most of these procedures are still experimental and do not have ample scientific research to back them as safe and legitimate treatment options, Medicare’s coverage is also limited. So does Medicare pay for holistic or alternative treatments? The answer is both yes and no.

Medicare Coverage: Holistic Medicine

Medicare does not cover alternative medicine, save for specific procedures that may be necessary for obtaining other regular healthcare treatments that fall under Medicare’s scope.

An example is chiropractic care that is needed for spinal manipulation-related procedures, which Medicare Part B shoulders. Another example is medical nutrition therapy, again under Part B, because it is part of the program for patients who have been diagnosed with a kidney disease or diabetes, or those who have undergone a kidney transplant within the last 36 months. Medicare will consider covering part of this service or the full bill, provided that patients have a referral from a qualified practitioner or their doctor.

Counseling is also not part of Medicare coverage, although you may avail of Medicare-approved services similar to this one, such as mental health therapy sessions and depression screenings.

Alternative Treatments Not Covered by Medicare

To be clear, there are alternative treatments that are really not covered under Medicare because they are not typically a prerequisite to any inpatient or outpatient procedure that qualify for free billing or subsidy. Most of these holistic treatments are taken as adjuncts to an existing medical plan or as second option by those who refuse traditional medical invention. As a general rule, Medicare shoulders procedures that are prescribed by medical doctors and are obtain through hospital care or outpatient clinical services.

Procedure
Covered by Medicare?
Acupuncture
No
Chiropractic services
Yes, Part B, but only when they are medically needed to correct spinal subluxation
Fitness programs
No
Health education and wellness programs
No
Humidifiers
No
Massage therapy
No
Naturopathic medicine
No
Nutrition therapy services
Yes, Part B, but there are specific qualifiers
Obesity screening and counseling
Yes, covers sessions to help patients lose weight in a primary care environment run by a qualified provider
Sleep apnea
Yes, Part B, but for a three-month trial session of CPAP therapy by a qualified provider.
Sleep studies
Yes, Part B. Medicare takes care of Type I, II, III, and IV sleep exams and devices.
Smoking cessation
Yes, Part B. Medicare shoulders up to eight in-person counseling sessions in a year with a qualified provider.

Medicare Part D and Holistic Treatments

  • Part D will only cover prescription drugs that meet these conditions:
  • With a Food and Drug Administration (FDA) approval
  • Available only by prescription
  • Used for a medically-approved purpose
  • Sold and used in the U.S.
  • Not already covered in Part A or Part B

That said, drugs that promise to help you gain or lose weight, fix sexual or erectile dysfunction, grow hair and other cosmetic purposes, prescription vitamins and minerals (except fluoride preparations and prenatal vitamins), fertility drugs, and over-the-counter drugs are not covered.

To understand how Medicare and Medicare Supplements (Medigap) play a role in your alternative approach to your senior years, it’s best to talk with a qualified SecureCare65 representative so you can weigh all your options first before making a decision. Talk to us at 1-800-354-1078.

What Does Medicare Pay for Chiropractic Care?

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A huge part of ageing and entering the senior years is the increasing need for chiropractic care. While not everybody will likely need any major spine alignment procedures, there are certain chiropractic procedures that will help senior citizens enhance flexibility, balance, coordination, and mobility. These procedures are also often necessary when a person starts to feel some discomfort and pain. Thus, the question of whether Medicare includes chiropractic care to its coverage is often asked.

Why Is Chiropractic Care Needed for Older Adults?

It is a fact of nature that bones do start to exhibit signs of wear as we get older and this amount can vary from person to person. Those who already are feeling the strain on their bones and joints are more likely to see the problem escalate to bigger mobility and posture issues, which when experienced with intense pain can indicate a pinched nerve. While this part of ageing is expected, it shouldn’t be a hindrance to enjoying one’s golden years. This is where chiropractic care steps in.

The common misconception is that chiropractic care is physically stressful because the manipulation techniques could place the elderly’s frail bones at risk. However, as chiropractors are also medical practitioners, it should be known that there are varying degrees of manipulation, depending on the patient’s needs and condition. This can be in the form of gentle massages and mobilization techniques, as well acupuncture or dry needling. All that said, chiropractic care is an essential part of the ageing process — so everyone can transition gracefully and as pain-free as possible.

What Medicare Pays for Chiropractic Care

The only chiropractic procedure that is covered under Medicare, Part B (medical insurance) specifically, is manipulation of the spine to correct a subluxation, which happens when one or more bones on the spine are out of their normal position. No X-ray is needed to prove this condition. It is also covered under Part B when it is medically necessary and if it is performed by a qualified chiropractic care provider or a licensed chiropractor. This includes both inpatient and outpatient care, such as lab testing, doctor visits, equipment, necessary surgical procedures, home health care and other directly related situations.

Medicare Part B covers 80% of this type of chiropractic care while the patient takes care of a small annual deductible. You may purchase supplement insurance or Medicare Supplement plans to help pay for such expenses. Take note that X-rays are not covered unless it was specifically ordered by the doctor to determine whether a subluxation does exist. The initial exam by the chiropractor to find out is a misalignment is present is also not part this. The coverage refers only to the adjustments that need to be made.

Chiropractic Care and Medicare Advantage

A popular way to obtain additional coverage for chiropractic services is to get a Medicare Advantage plan. Note that they may cover such services, though what they include and how much of a copayment the patient must pay are not standardized. Providers of Medicare Advantage plans have the liberty to set their own packages of benefits, and pricing so it’s best to shop around and compare offerings before signing up for anything.

Medicare Advantage plans typically offer the same services as Medicare Part A and Part B, but the difference is that they are limited by their network of healthcare professionals. This means that you should seek medical consultations and assistance only from the providers on their list if you want to gain full advantage of this plan. In addition, unlike Medicare that lets patients pay a deductible and then they cover 20%, MA charges via a copay system — and, again, this can vary depending on the time of treatment and the services rendered.

Chiropractic Care and Medicare Supplements (Medigap)

Having a Medicare Supplement plan will also help in reducing the expenses or getting some of the procedures related to chiropractic care for free. For example, some Medigap plans can cover all of the Part B coinsurance and copayments, which may include chiropractic office visits for a subluxation. Medicare Supplement Plans F and G can take care of Part B excess charges, while Plans C and F can shoulder the Part B deductible. Plan will require you to shoulder a copay of $20 for doctor visits, while Plans K and L will have you making 50% and 75% in out-of-pocket costs, respectively.

To further understand how a Medicare Supplement figures into your specific needs for chiropractic care, it is best to talk with a qualified SecureCare65 advisor so you can see all the choices available for your situation and budget. You can give us a call at 1-800-354-1078 so our team can answer your questions immediately.