Is Medical Marijuana Covered by Insurance?
Article written by
Shanti RyleContent Writer
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
Table of contents
Medical marijuana is currently legal in 37 states as of 2021, and as such, it makes sense to assume that your medical cannabis would be covered by health insurance. However, this is unfortunately not the case.
Most public and private insurance companies won’t pay for medical marijuana recommendations or use, even in legalized states, because it’s still technically illegal on a federal level.
According to federal law, cannabis is still a Schedule 1 substance, with no recognized medicinal use and a high potential for use. This makes medical marijuana nearly impossible to research so that even if the DEA rescheduled it, the process of adding it to health insurances’ drug formulary would take years.
This means that no part of using medical cannabis – including doctor’s visits, registration for a medical marijuana card, and purchasing the medicine – is currently covered by insurance or likely to be any time soon, except in some states. But that doesn’t mean it needs to be wildly expensive to use medical marijuana.
Personalized Cannabis Guidance
As a national health insurance organization operated by the U.S. federal government, Medicare cannot cover medical marijuana because of its federal legal status. Medicare must act according to federal law as a public entity, even though cannabis is currently legal for medical use in 75% of states.
Due to its Schedule I status, researchers face an uphill climb in researching cannabis and proving its medicinal use. While the DEA moving it to a lower schedule (II or III) would unlock the doors to research, it would take even longer to accumulate a body of research to win U.S. Food and Drug Administration approval for federal medical cannabis use.
After this, there would be a probationary period where major pharmaceutical companies, such as Moderna and Pfizer, would have exclusive access to cannabis-based formulations. And after all this, only then would Medicare consider adding these particular formulations to its drug formulary and cover them for its patients.
There are, however, currently a handful of cannabinoid-based prescription medications that the FDA has approved. Epidiolex, a CBD-based tincture for treating seizures, is the only one that contains natural cannabinoids derived from cannabis.
Synthetic versions of THC, notably Cesamet, Marinol and Syndros may also be available via prescription, usually for cancer patients and those going through chemotherapy or cachexia due to AIDS/HIV. However, these versions of synthetic THC are actually more potent than natural THC. Many patients actually prefer cannabis-derived THC, with all of the other cannabinoids and terpenes that come with it.
Medicaid is another federally-operated health insurance organization, specifically helping low-income patients to access affordable health care and medicine. However, due to its public status, Medicaid cannot cover any portion of medical marijuana, though some states offer reimbursement for the visit involved with receiving a doctor’s recommendation or certification.
New York offers Medicaid services reimbursement through Medicaid for patient evaluation and certification, though not for products. New Hampshire and New Mexico, conversely, allows for the reimbursement of medical marijuana purchase on a state level.
Court cases in Pennsylvania, and New Jersey, more recently, have successfully argued for medical marijuana reimbursement in the case of workers’ compensation.
However, on a national level, Medicaid is in the same boat as Medicare and will likely not assist with medical marijuana for several years.
Private Health Insurance Plans
Most private health insurance plans refuse to cover medical marijuana-related visits and services. As these companies operate on a national level and must comply with federally-mandated coverage requirements, most don’t want to risk entering the illegal territory of medical cannabis, despite its legal status in so many states.
Were the DEA to reschedule or Congress to legalize cannabis, it’s still likely most insurances won’t cover your purchase. After all, most plans don’t cover purchases of over-the-counter Tylenol or vitamins, though a Health Savings Account (HSA) may someday accommodate medical cannabis.
Some entrepreneurial companies are attempting to address the needs of the many patients who need access to affordable cannabis medicine. Novus Cannabis MedPlan is one such new company, but it remains to be seen whether it and those like it can effectively and reliably provide insurance coverage for medical marijuana.
Does Having a Medical Marijuana Card Affect Health Insurance Costs?
Medical marijuana does not affect health insurance costs or coverage in most cases. Some life insurance providers may raise their rates if you use medical marijuana, but this is uncommon.
Medical marijuana use could also potentially affect your car insurance rates if you’re involved in a collision or traffic stop and are discovered to be driving under the influence.
Assistance and Tips for Affordable Medical Marijuana
Understandably, it can be daunting to consider the total costs of medical marijuana without the benefits of an insurance plan. Many medical marijuana patients who struggle to afford much-needed medicine add more stress to the debilitating medical condition they’re already combating with the plant.
Typically, a gram of flower costs between $5-20, an eighth oz/3.5 grams costs $20-60, and an ounce can cost up to $400. Finding creative ways to stretch your flower, store it, or buy in bulk, can help keep costs down. You can also buy medical marijuana in concentrated forms, such as vape cartridges or cannabis oil, which have a longer shelf life and more bang for your buck.
The good news is many states, cities, and dispensaries offer assistance and reduced-cost programs to medical marijuana patients in need. Some medical cannabis programs offer discounted or free registration to obtain an ID card, depending on your state. Many dispensaries also partner with their patients, offering discounted prices, sales, or patient-relief programs to help individuals access the medicine they need.
Doctors have taken it upon themselves to reduce costs for obtaining a medical marijuana recommendation. Leafwell only charges patients if approved, and visit prices are comparable to the copays for many health insurance plans.
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Frequently Asked Questions
Does insurance cover CBD oil?
Currently, CBD oil is not covered by insurance. It is federally considered a supplement, which most public and private health plans don’t reimburse.
The one CBD-based prescription medication covered is Epidiolex, an FDA-approved drug used to treat rare forms of epilepsy.
Do you need insurance to get a medical card?
You do not need insurance to get a medical marijuana card, and most medical insurance companies don’t cover products or services related to it due to its federal status, at least in most states.
Are there any states that allow for insurance to reimburse for medical marijuana expenses?
In general, most states do not cover products and services related to medical cannabis qualification or marijuana products. There are four exceptions to this, however: New York, New Jersey, New Hampshire and New Mexico. Pennsylvania is a possible fifth.
New York allows for insurance to cover the costs of evaluation and certification (not products). New Mexico allows for an injured worker to potentially claim back the cost of medical cannabis purchase. In one case in New Hampshire, the Supreme Court “held that the law does not create any exceptions in the workers’ compensation carrier’s ongoing obligation to pay for all of the claimant’s reasonable medical treatment – up to and including his use of therapeutic cannabis.”