Does Medicare Cover Pain Management?
Pain management is a broad term that applies to a number of different medical treatments and therapies. Original Medicare can cover many of these services, including physical or occupational therapy. Some pain medication coverage may only be available through a Part D prescription drug plan.
Conditions That May Benefit From Pain Management
Many conditions — ranging from minor conditions that result in some discomfort to serious ailments that need to be managed regularly — can benefit from pain management. Pain management can be especially critical to older adults.
According to the National Institute on Aging, there are two main types of pain that typically need to be managed: acute pain and chronic pain.
Acute pain results suddenly from the result of a new condition like a broken bone and will go away in a short amount of time as that condition heals. It is typically the less serious of the two.
Chronic pain — which often affects older adults — lasts for three months or longer and is not as easy to manage. Chronic pain can result from a condition that doesn’t quickly heal or go away with ease, and pain management can be vital to dealing with chronic pain.
Pain Management Services Covered by Original Medicare
Original Medicare helps pay for a wide variety of pain management services. While not every service is covered, Medicare Part B typically pays 80% of the Medicare-approved costs for a variety of approved pain management therapies and treatments.
Medicare covers acupuncture when related to pain management, but only in specific circumstances.
Typically, acupuncture care is only covered if it is being used to help manage chronic lower back pain. Acupuncture, even when used to help manage other types of body pain or non-chronic pain, will typically not be covered.
Medicare traditionally only covers treatments that are medically necessary, so you would have to pay out of pocket for any acupuncture services related to non-pain or non-medical purposes.
There are some scenarios where Medicare will cover chiropractic care to help manage pain. Typically, manual manipulation of the spine by a chiropractor is covered if you have a subluxation — meaning that a bone in your spine has moved out of its usual position.
It’s important to note that — although Medicare covers chiropractic care under these circumstances — it doesn’t automatically cover other related services, even when ordered by your chiropractor. These include x-rays and massage therapy.
Physical therapy relies on massage, heat treatment and exercise instead of drugs or surgery to treat pain, injury, disease or deformity. Original Medicare will typically cover your physical therapy. As with other types of coverage, the therapy must be a medical necessity in order for you to receive coverage.
Typically, you can choose your own physical therapist, but Medicare will only pay if the therapist accepts Medicare. There is no limit on how much Medicare will pay for outpatient therapy services in a year.
There’s also no limit on where you can receive the care: Original Medicare covers both inpatient and outpatient physical therapy that is medically necessary, as well as physical therapy that must take place in your home.
Because there is a wide variety of pain management options available under Medicare, you should talk with your doctor about all of your treatment options.
Pain Management Medications Covered by Medicare
While Original Medicare covers some treatments related to pain management, the vast majority of medications outside of those used in hospital settings are not covered.
Despite the fact that medical marijuana is now legal in several parts of the United States, Medicare will not cover it for pain management or for any other use.
This is because Medicare is a federal program. Even though some states have modified their marijuana laws, federal standards still consider it illegal. For that reason, Original Medicare will not cover it.
The state you live in does not affect whether or not Medicare will cover your medical marijuana.
Prescription drug coverage is largely unavailable through Original Medicare. This means that you have to pay for any prescribed drugs on your own.
Drug coverage is available through a Medicare Part D prescription drug plan, which is sold through private insurers and is separate from Original Medicare. Medicare Advantage plans often include Part D coverage as well.
Over-the-Counter (OTC) Drugs
Original Medicare typically does not cover over-the-counter drugs, meaning you will have to pay for them on your own. Part D prescription drug plans also rarely cover over-the-counter drugs.
There are some Medicare Advantage plans that can include an over-the-counter allowance.
Pain Management Costs Medicare Part D Drug Plans Cover
Medicare Part D prescription drug plans can help handle the costs of prescription medications used to deal with pain management.
Plans typically come with a formulary of drugs that are covered under that specific plan. Since the plans are provided by private insurance companies, the exact list of drugs covered can vary.
Prices can also vary widely. Unlike with Original Medicare, there is no set, nationwide price. Different plans will come with different costs.
- Medication Therapy Management Programs
- These are programs that help people with complex health needs — typically when you take different medications for different conditions. You and your doctor, a pharmacist and other health care providers will review your drugs and develop an action plan to best use your medications. They will identify potential side effects and interactions and also see if you can lower your drug costs.
- Opioid Pain Medication
- Prescription opioid pain medicine can sometimes be used to manage severe pain. But your Medicare Part D prescription drug plan may put restrictions on their use and availability under your coverage.
Medicare reacted to the opioid epidemic of the 2010s by introducing additional opioid safety protocols for Medicare Part D plans. These included safety alerts at pharmacies for Part D enrollees who were filling their first opioid prescription and for those receiving high doses of the drugs.
The expanded rules seek to identify potential safety risks while not interfering with people who need access to prescription opioids due to a medical necessity, according to the U.S. Centers for Medicare & Medicaid Services.
It’s also important to remember that many Medicare Advantage plans can include Part D coverage. Medicare Advantage plans must cover everything that is included in Original Medicare but also often come with additional benefits and expanded coverage as well.
The amount of your benefits and the drugs that your plan covers can vary from plan-to-plan. It’s important to contact your Part D or Medicare Advantage plan administrator to find out exactly what is covered.
How to Find a Pain Management Doctor Who Accepts Medicare
If you have Original Medicare, it’s important to remember that any treatments and services you receive will only be covered if you are seeing a doctor who accepts Medicare. Be sure to ask a prospective doctor if they do before being treated.
If you are looking for a specific pain management doctor or a pain management clinic, a first step can be to ask your regular doctor for a referral.
The Center to Advance Palliative Care also has resources to locate and direct you to clinics in your state.
Depending on where you live, there may be advocacy groups or pain management groups that can help you find the right doctor and clinic.
Your local or state health department can also help direct you towards the resources that you need.
Your Pain Management Costs in Medicare
Since most pain management treatments and services fall under Part B, Medicare will handle 80% of the cost.
This means that you will be responsible for 20% of the cost of any page management therapy you receive after you have met your Part B deductible. The deductible for 2022 is $233.
What you pay may be different if you receive care in a hospital as an inpatient.
If you do not have a Part D prescription drug plan or Medicare Advantage plan that includes drug coverage, then you will have to pay the full cost for any drugs to manage pain.
You will also be responsible for 100% of the cost of any pain management therapies or services that Medicare does not cover.
5 Cited Research Articles
- National Institute on Aging. (2018, February 18). Pain: You Can Get Help. Retrieved from https://www.nia.nih.gov/health/pain-you-can-get-help
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Acupuncture. Retrieved from https://www.medicare.gov/coverage/acupuncture
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Chiropractic services. Retrieved from https://www.medicare.gov/coverage/chiropractic-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Pain management. Retrieved from https://www.medicare.gov/coverage/pain-management
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Physical therapy. Retrieved from https://www.medicare.gov/coverage/physical-therapy