According to an April 2022 poll conducted by the Medicare Plans Patient Resource Center, a group that provides Medicare guidance and information, one in every five Medicare participants currently utilizes medical marijuana. And about a fifth have previously used it. According to the poll, two-thirds of Medicare enrollees believe Medicare should cover it.

However, because medicinal marijuana is not federally legal and has not been approved by the Food and Drug Administration, Medicare does not cover it. Here's the current state of affairs.

Why cover medical marijuana for older adults?

According to an April 2022 research published in the journal Cannabis and Cannabinoid Research, 60% of patients at a prominent cannabis dispensary in New York were 50 or older. Patients utilized cannabis for a variety of reasons, including severe or chronic pain, cancer, Parkinson's disease, and neuropathy. 

And marijuana isn't cheap: according to New York Cancer & Blood Specialists, which treats cancer and blood diseases, patients may pay as much as $5 per dose for edible items or $5 to $20 per gram for plant buds. (This equates to $142 to $567 per ounce.) Even in states where medicinal marijuana is permitted, individuals may be unable to afford the prescription.

"This medicine is so expensive," says Debbie Churgai, executive director of Americans for Safe Access, a non-profit organization dedicated to securing safe and legal access to cannabis for therapeutic and scientific purposes. "There are some states now where insurance will cover the cost of a doctor visit or a marijuana card, but no insurance will cover the cost of the actual products." 

What are the federal roadblocks?

Two major difficulties lie in the way of medical marijuana and Medicare coverage. The first is that marijuana is classified by the government as a Schedule I Drug, which means it has "no currently accepted medical use and a high potential for abuse" in the United States, according to the Drug Enforcement Administration.

"There is no way the federal government is going to reimburse people for a substance they deem illegal through a federal program," says Paul Armentano, deputy director of NORML, the National Organization for the Reform of Marijuana Laws. 

The second difficulty is that Medicare mandates that a covered drug be approved by the FDA as safe and effective. Although the FDA has approved one cannabis-derived medicine product and three synthetic cannabis-related medicinal products for prescription use, it has not allowed cannabis marketing for medical treatment.

What about in states where it’s legal?

While marijuana is still banned at the federal level, it is currently permitted for medical use in 37 states and Washington, D.C. Could commercial insurers, such as those who provide Medicare Advantage, elect to cover it? 

According to Kyle Jaeger, a cannabis policy reporter and senior editor at Marijuana Moment, a cannabis news website, this seems unlikely. Major health insurers, like banking institutions that have been hesitant to offer services to marijuana firms, will most likely refuse to cover cannabis as long as it is classified as a Schedule I substance under federal law. 

Furthermore, private insurance rely on the FDA to determine which pharmaceuticals to cover. Consider that the FDA stated in January that present regulatory procedures are insufficient for the agency to designate CBD as a dietary supplement.

"It's incredibly frustrating for consumers, because all they want is a safe, consistent product," adds Jaeger. 

How high is the bar for cannabis coverage? 

Among other reasons, the market requires additional data on cannabis's medicinal use. "(Insurers) need data to show that the outcomes from cannabis care are equivalent to, if not better than, existing options that they do cover," says Dr. Benjamin Caplan, the founder and chief medical officer of CED Clinic, which offers cannabis treatment services. 

The free-market dispensary system, in which patients are able to purchase any product, complicates matters. "The system has to be tweaked," Caplan adds. "Patients cannot be given carte blanche to buy whatever they want and expect insurance companies to cover it." 

The road to cannabis coverage is lengthy, according to Jaeger, given the range of legal and regulatory impediments that must be overcome, as well as a reorganization of the dispensary system. "I'd say we're many years away from having that conversation and rulemaking for something like Medicare."