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Medical Marijuana and Medicare Coverage

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As more states embrace the idea of medical marijuana, many Medicare beneficiaries wonder, “Does Medicare pay for medical marijuana?” Often, the question stems from the fact that cannabis is still illegal at the federal level.  Medicare is a federal government program.

The Federal Government’s Stance on Medical Marijuana

Marijuana is a Schedule 1 controlled substance. The federal government believes that it has a high potential for abuse. It states that there is no accepted medical treatment that utilizes medical marijuana. Additionally, they assert that there are no accepted safety standards regarding the use of marijuana as a medical treatment.

Additionally, the Food and Drug Administration (FDA), the federal government agency which approves prescription drugs, has not recognized marijuana as a medicine.

Does Medicare Pay For Medical Marijuana?

No. Marijuana is not an approved treatment for any medical condition and not officially classified as a medicine. Therefore, Medicare will not cover medical marijuana, regardless of whether a beneficiary has a prescription.

Is There Any Medical Marijuana Insurance Coverage?

Probably not. Most private insurance companies take the same stance as the federal government in regards to marijuana as a viable treatment option for any medical condition, even if you have a prescription. This means that medical marijuana insurance coverage essentially does not exist.

Are There Any Marijuana-Based Medications?

Yes. The FDA has approved medications such as those containing cannabinoids, which are chemical compounds found in marijuana that can assist with specific health conditions.

For example, Marinol (dronabinol) contains cannabinoids, and often treats severe nausea and vomiting. They are often used with chemotherapy, and to increase the appetites of persons with AIDS.

Epidiolex (cannabidiol) is an oral solution that contains CBD, a chemical substance in marijuana that does not produce the euphoria or intoxication that commonly comes with marijuana use. It is used to treat seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. These are both two severe forms of epilepsy.

Medicare does cover Marinol and Epidiolex through Medicare Part D and Medicare Advantage plans. Many private insurers will offer coverage as well.

Can You Use Medical Marijuana as a Medicare Beneficiary?

If medical marijuana is legal where you live, you may be able to use it even it if you are a Medicare beneficiary. As long as you have a current prescription, you can purchase medical marijuana on your own.

However, any costs associated with the purchase of medical marijuana will not go toward your Medicare prescription drug plan out-of-pocket maximum. This means the financial burden is entirely on your shoulders.

Additionally, since medical marijuana is not legal at the federal level, you cannot claim the cost as a medical expense on your federal income taxes. This is true regardless of whether it is legal in your state.

States also will not allow medical marijuana to count as a medical expense deduction. The majority of states follow federal rules regarding what is deductible, using your federal adjusted gross income as a basis for state income taxes. This means you cannot separately deduct the expense on your state taxes alone.

Is Medical Marijuana Different from Recreational Marijuana?

No.  By and large, medical marijuana isn’t different from recreational marijuana in states that have made both legal. Both options come from marijuana plants and feature many of the same chemicals.

However, there can be differences between individual marijuana products. Delta-9-tetrahydrocannabinol (THC) and CBD levels can vary from one strain or product to the next, impacting how “high” a person feels, how much it reduces pain, and similar effects. In states where medical and recreational marijuana are both legal, legislation often requires packaging that identifies how much THC and/or CBD is present. This serves as both a regulatory measure and it helps to inform buyers.

There are factors that may affect illegally purchased marijuana, such as the marijuana you purchase through a local drug dealer. Product purchased on the street may contain other substances, including potentially hazardous ones, or have varying compositions that impact effectiveness.

Ultimately, Medicare and other insurers are not likely to cover medical marijuana unless it is made legal at the federal level and becomes an FDA-approved treatment for specific medical conditions. Until that time, even those with prescriptions will have to manage the costs on their own.

Have you or someone you know ever used medical marijuana? Tell us about it in the comments below.

What You Should Know About Medicare Part D Coverage Changes

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Medicare Part D experiences changes on a regular basis. In most years, premiums can shift, along with deductible caps, and overall coverage.

For 2018, it was estimated that the average monthly premium for Medicare Part D would decline. It’s estimated to fall from $34.70 to $33.50 each month. However, each subscriber may have varying experiences. This is due to cost differences by physical location.

Other noteworthy Medicare Part D changes for 2018 included a slight increase to the deductible caps. The coverage gap narrowed slightly.

Additional changes are expected in 2019 as well. Here’s what you need to know in relation to Medicare Part D coverage for 2019.

Opioid Restrictions

medicare part d

Medicare is putting certain restrictions in place as the opioid crisis continues to cause harm across the nation. The hope is that these restrictions can combat the issue. Beneficiaries at risk of developing addictions, particularly those with a history of addiction, may not have the same level of access to opioids as in previous years.

However, some patients, such as hospice and cancer patients, will not be subject to restrictions.

Cost Reductions

The Centers for Medicare & Medicaid Services (CMS) announced at the end of July that the average basic premium for Medicare Part D is expected to decline in 2019. This marks the second year in a row where a downward shift will occur.

While the exact savings may vary from one beneficiary to the next, the new average monthly premium is expected to be $32.50. The new premium represents a savings of about $1 per month.

While the details are not fully known, some Medicare Part D users will also see lower costs for specific generic drugs. Requirements regarding cost-sharing for some generic prescriptions may shift. This should lead them to be less expensive for the beneficiary.

Deductible Cap Increase

Medicare Part D’s standard initial deductible represents the out-of-pocket expense before the prescription drug plan begins to cover any costs.

The standard initial deductible for 2018 is $405, and will rise to $415 for 2019. Since 2015, this cost has steadily increased. The cost has risen from $320 in 2015 to $360 in 2016. The next increase came in 2017 at $400 and finally reached $405 in 2018.

Formulary Changes

In 2019, there will be more flexibility regarding the substitution of generic medications for brand-name drugs or similar formulary changes. This provides pharmacies with additional options, which may result in the reduction of out-of-pocket costs especially as many generics are less expensive than their brand-name counterpart.

Coverage Gap Narrows

For 2018, the initial coverage limit was $3,750. After reaching this amount, beneficiaries enter the “donut hole,” or a period where their prescription drug costs exceeded the limit.

After reaching the limit, beneficiaries must cover the total costs of their remaining prescription drug costs for the year. This additional cost can be burdensome, until the yearly out-of-pocket maximum is achieved. However, generic drugs do still have a 56 percent discount. This discount is available once the beneficiary enters the donut hole. Brand-name medications also receive a discount.

In 2019, the initial coverage limit will rise to $3,820. This means more prescription drug costs are being covered by Medicare Part D. Additionally, generic drugs will have a discount of 63 percent and brand-name medications will have a 75 percent discount, which represents an increase. This could make affording medications more manageable.

Plus, even though prescriptions drugs are purchased at a lower price while a beneficiary is in the donut hole, they will receive a credit for 95 percent of the medication’s value. That applies to the out-of-pocket maximum in 2019, which may allow the upward limit to be hit more quickly.

Total Out-of-Pocket Maximum Increases

The point where a beneficiary exits the donut hole is set to rise by $100 in 2019. This brings the maximum from $5,000 in 2018 to $5,100 in 2019.

Open enrollment for Medicare Part D begins on October 15, 2018, and runs through December 7, 2018. During that window, current beneficiaries can select a new prescription drug plan. They can look for one that better aligns with their needs and budget. Seniors must also take into account any changes put forth in the updated program.

Have you had any experience with Medicare Part D? If so, tell us about it below in the comments.

FDA Warns of People Abusing Their Pets’ Opioid Prescription

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In 2015, the opioid crisis cost the American economy an estimated $504 billion, or 2.8% of the GDP. Although many government agencies are working diligently to get this problem under control, people are finding loopholes and new ways to access these seriously addictive drugs. Now the Food and Drug Administration (FDA) is warning that individuals may be abusing their pets’ opioid prescription.

The ongoing opioid crisis results in more than 1,000 emergency room visits and 115 deaths every day in the United States. FDA Commissioner Scott Gottlieb has been working with physicians to place more strict rules on opioids. However, he is now asking veterinarians to join the efforts as well.

According to a paper recently published in the American Journal of Public Health, 189 vets in Colorado completed an online survey. Of these, 13% reported being aware that an animal’s owner had intentionally made an animal ill or injured an animal to get an opioid prescription. Forty-four percent reported knowing of opioid abuse or misuse by a staff member or client and 12% were aware of a staff member abusing opioids.

Gottlieb responded to these findings by asking vets to help ensure that there’s a balance between caring for animals and providing humane treatment for their pain, while still addressing the epidemic of misuse and abuse. This began yet another debate centered around the systems put in place to help fight opioid addiction, one of the main issues of the epidemic.

However, at no point in the process of prescribing an opioid does a vet have to consult the owner’s medical history or potential history of abuse. In fact, a vet would need special clearance to even get that information. There are no systems in place to track opioid prescriptions at the vet, nor any set way to deal with misuse amongst staff members and clients.

Both Colorado and Maine enacted laws that made it mandatory to check an owner’s medical history before prescribing their pet opioids. There was an outrage among vets and pet owners because choices for treating pain in an animal are limited.

“We recognize that opioids and other pain medications have a legitimate and important role in treating pain in animals – just as they do for people,” Gottlieb noted in a report last week. “But just like the opioid medications used in humans, these drugs have potentially serious risks, not just for the animal patients, but also because of their potential to lead to addiction, abuse and overdose in humans who may divert them for their own use.”

There is only one opioid approved for use in animals. Because there are very few approved medications for animals, vets are forced to prescribe Recuvyra, a human opioid medication, when the animal is in pain.  Recuvyra is a form of fentanyl, a drug that has killed thousands of Americans already and was even used to kill an inmate on death row just last week in Nebraska. More research is needed to explore alternative ways of treating an animal’s pain.

“As medical professionals, veterinarians have an opportunity to partner with the FDA and others to take on this public health crisis,” Gottlieb said. “We encourage them to continue to work with their clients and both local and national organizations, such as their state board of veterinary medicine and AVMA, to join in the fight against this tragic epidemic.”

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Is Short-Term Medical Insurance Worth It?

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In 2016, 28.1 million Americans were uninsured for the entire year. However, with recent changes to the healthcare mandate, that number may rise, particularly since premiums are largely going up.

The most popular plans available through the Affordable Care Act (ACA), also known as Obamacare, saw premiums soar by an average of 34 percent in 2018. In 2019, Californians can expect their cost to rise by almost 9 percent. In Washington State, insurers are proposing a 19 increase on average. The CareFirst of Maryland’s Blue Preferred offering may raise rates by a stunning 91.4 percent.

Now that Obamacare is changing, many people will begin to explore alternatives, one of them being short-term medical insurance. However, many wonder if short-term health insurance is worth the cost and if it provides enough coverage to be an effective option.

What is Short-Term Health Insurance

Short-term health insurance plans are products that typically come with a much lower cost in comparison to traditional options. For example, according to a report in late 2017, for a 55-year-old male in Indianapolis, the cheapest ACA plan was $563 a month. How much was a short-term health insurance plan? $103 each month.

However, they also come with a big caveat; the coverage typically only lasts for 90 days at a time.

It is important to note that the US Department of Health & Human Service is asking for the removal of the 90-day plan length limit. Ideally, they want coverage to last up to 364 days, just one day shy of a year. But, that isn’t the current state of the limitation, and there’s no guarantee the change will go through.

Further, some insurers allow people to buy up to four 90-day periods at a time. This means completing only one application and going through a single underwriting process. Then, the plans are valid sequentially, providing 360 days of coverage.

While you might be able to secure close to a year of insurance, it usually isn’t the kind of coverage you would be hoping to find. Mainly, this is because these plans don’t meet ACA standards.

Since they don’t meet ACA standards, they insurer can use higher deductibles, lower caps, and additional restrictions on a variety of medical treatments. This makes the monthly cost low, but that doesn’t mean you won’t pay big if you use the coverage.

Is Short-Term Medical Insurance Worth the Cost?

Even with a short-term medical insurance plan, a person could still be left with massive medical bills. Largely, these options don’t provide a substantial amount of coverage and have numerous limitations.

For example, the plan might not include prescription drug or maternity coverage or could charge extra to add these features. Excluding pre-existing conditions (which includes anything you’ve received treatment for or experienced symptoms of in the last five years before securing the plan) is also common.

Some insurers will even limit or deny treatments if a person discovers a severe condition, like cancer, within 30 days of the policy starting.

Additionally, a serious illness after the policy starts may lead the insurer to refuse to renew your plan later. This means, after the 90 days, you may not have any coverage options with them.

Traditionally, short-term health insurance also comes with deductibles that are higher than the maximums set in the ACA. That $103 a month plan mentioned above has a $5,000 deductible. This means you’d have to spend $5,000 in medical costs before the plan even kicks in.

After that $5,000, the plan only covers 50 percent of a person’s medical bills, in the majority of cases, until you spend an additional $5,000 in out of pocket expenses. Plus, there are still other limits and caps to contend with, like a $500 cap on ER visits.

ACA-compliant plans adhere to specific guidelines, including coverage for pre-existing conditions and more favorable out-of-pocket maximums. Plus, they can’t have as many exclusions as a short-term medical insurance plan, making your coverage more comprehensive.

Should You Try a Short-Term Health Insurance Plan?

Ultimately, your unique situation will determine whether a short-term medical plan is right for you. However, it is crucial that you read the fine print to learn about the coverage, exclusions, deductibles, and caveats before you make that decision.

Additionally, it’s important to note that not all states allow short-term plans. People in Massachusetts, New Jersey, New York, Rhode Island, and Vermont can’t purchase these forms of coverage at all. Specific states may also restrict each renewal period further, making them last less than three months.

In the vast majority of cases, short-term health insurance isn’t a cost-effective option. However, some plans are better than others. You may find one with lower deductibles, fewer restrictions, and favorable out-of-pocket limits. Typically, these will cost more than less comprehensive plans, but they can help avoid financial ruin at a much lower price tag.

When in doubt, consult with a state-licensed broker if your state-run exchange has them. These professionals can help you assess your options and determine which one fits your financial situation while respecting your personal healthcare needs.

However, if an ACA plan is available, even if the monthly cost is higher, you could be better off with the insurance. A single medical event can be catastrophic financially, and ACA-compliant plans provide substantially better protection.

Have you ever used short-term medical insurance? Tell us about your experience in the comments below.

Looking for more great insurance articles? Here are a few to get you started:

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How to Get Free Dental Work

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As of 2016, around 23 percent of Americans had no form of dental insurance. Without insurance, many people find even basic dental work, like cleanings and exams, to be unaffordable. However, even with coverage, the out-of-pocket expenses for treatments might not be feasible within a person’s budget.

A root canal can be as much as $1,500 to $2,000 on average, depending on the tooth. Porcelain crowns can cost $3,000. Even a single filling can carry an expense of $150 to $200 per one to two surfaces.

The high cost of many dental treatments means people with serious conditions might not know what to do if they need treatment. In some cases, they may choose to forgo receiving any care, largely because they can’t afford it.

However, there are options for keeping the costs under control. In fact, you may be able to get free dental work.

How to Get Free Dental Work

There are a variety of resources that may provide free dental work to individuals. However, not everyone qualifies in every case.

For example, some programs focus on those who have low incomes or meet other criteria, like being a military veteran. Others may involve a level of risk.

If you are looking for free dental work, it’s important to check a few options. While you might not be eligible in one program, you may qualify in another. Here are some resources that are worth exploring.

Dental Insurance

If you have private dental insurance, specific preventative treatments, like cleanings and exams, may be 100% covered by the insurer. However, this varies depending on the insurance provider and the exact plan.

In some cases, Medicaid of CHIP dental plan may cover some treatments fully, but that isn’t always the case. These plans exist on the state-level, so each state controls what is and isn’t covered in full. It is important to note that these plans are incredibly limited for both children and adults, but they do provide basic coverage to those who qualify.

Dental Schools

The only way to ensure an aspiring dentist or hygienist has the proper skills to work in the field is to allow them to practice on actual patients. In exchange for allowing a dentist or hygienist in-training to work on you, they lower the cost of treatment.

Typically, the prices are only reduced. However, many colleges and universities use a sliding scale. Low-income households may qualify for no-cost treatments, though this is up to the school itself.

There is a small level of risk of going to a dental school since the person primarily responsible for your care is still training. But, it’s important to note that trained dentists do check their work and monitor their activities, so they are available to intervene if the need arises.

Clinical Trials

If you are willing to participate in a clinical trial, you might be able to receive free treatments. In most cases, you have to have a highly specific dental, craniofacial, or oral condition to qualify, and being willing to be a research subject.

The National Institutes of Dental and Craniofacial Research (NIDCR) at times seeks volunteers. You can review their current trials and see if you may be eligible.

In most cases, seeking out a clinical trial isn’t ideal if you suffer from an acute situation, like a broken tooth, or any circumstance where delaying treatment is unwise, like an infection. Those with chronic conditions may benefit, but every clinical trial comes with risk. Often, the course of treatment is unproven, so the results are not guaranteed and could even potentially be harmful. Before you take part, the researchers will disclose all of the known risks of receiving the treatment.

State and Local Health Departments

While health departments don’t provide care, they are very knowledgeable about resources in their areas. Consider contacting your health departments to see if they can refer you to a free dental care provider.

They may also be aware of financial assistance programs that can assist in covering the cost. Some charitable organizations may provide funds to individuals in need of treatment and repayment might not be necessary.

Department of Veterans Affairs

Qualifying veterans may have access to a variety of dental benefits through the VA. In some cases, the coverage is fairly comprehensive, though not every procedure will be free. Others might have access to a dental plan at a lower cost, making coverage more affordable.

However, one benefit veterans who recently served can access does allow for a one-time course of free dental care. To be eligible, veterans must apply within 180 days after they are discharged.

Community Clinics

Some community clinics provide dental care either for free or at a reduced price. Typically, income limits apply, but that isn’t always the case. Many of the locations are independently operated, so they may have some flexibility regarding who is eligible for free treatments.

What If You are Not Eligible for Free Dental Work?

Not everyone qualifies to receive free dental work. However, there are options to help make your treatment more affordable.

For example, you can find 0% interest financing options, such as those available through CareCredit. CareCredit is a credit card that only works at eligible dental, medical and veterinary providers. You’ll need to make monthly payments but, if you are able to pay the debt in full within the specified period, you don’t pay any interest.

While financing your dental work may not be ideal, it can provide you with the means to receive important treatments without incurring interest. Plus, since you can make payments over time, sometimes as long as 24 months, it can make the cost easier to handle.

Ultimately, all of the options above are worth exploring if you need free dental care. Even if you don’t qualify for no-cost treatment, you may find a cheaper alternative to paying the prices at a regular dental office. In some cases, the lower prices can make dental care reasonably affordable, so consider that approach as well when you need treatment.

 

Do you know of another way to get free dental work? Tell us about it in the comments below.

 

Looking for more great health articles? Here are a few to get you started:

The High Cost of Some Prescription Drugs Can Be More Than Most Automobiles

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According to Kelley Blue Book, the average price for a new light vehicle is $35,411. Even the lowest priced new cars will usually run over $12,000. While that number may not be a surprise. Due to the high cost of some prescription drugs;  many consumers are caught off guard when it’s time to pick up their prescriptions.

To make matters worse, some health insurance plans don’t help with the cost.

The High Cost of  Some Prescription Drugs

Tier one medications, typically name-brand drugs that manufacturers push through marketing campaigns, are often more expensive. In 2016, $5.6 billion was spent on prescription drug advertising, trying to convince consumers to ask their doctors about specific medications. These ads usually don’t discuss the cost of the drugs and selecting the wrong one could hit your wallet hard.

To help you make smarter decisions about your prescription medications, here are 11 that cost more than a car, according to GoodRX.

1. Actimmune

Actimmune is for the treatment of chronic granulomatous disease, a rare condition that impacts the immune system, and severe, malignant osteopetrosis .

Most patients need 12 vials a month, and Actimmune costs $4,360 per vial. That brings the monthly total to $52,321. If you use it for a year at that rate, your annual cost is a stunning $627,852. With various discounts and rebates and patient compliance, the cost can be lowered an average of $24,000 per month or $288,000 per year.

2. Daraprim

Both those with AIDS and transplant patient may use Daraprim, as well as those battling with toxoplasmosis. Typically, people use the medication for a few months.

A single one-month supply, consisting of 60 tablets, costs $45,000, or around $750 a pill.

3. Cinryze

A treatment for the rare, life-threatening condition hereditary angioedema, which causes swelling in various body parts, Cinryze costs around $44,140 for a typical one-month supply. Over the course of a year, that comes out to $529,680.

4. Chenodal

While a generic of Chenodal could technically be created, since the patent has expired, the “closed distribution system” has prevented generic manufacturers from producing the medication.

A typical 90 pill monthly supply of the gallstone dissolving drug usually runs about $473 per tablet or $42,570 in total. However, some patients need 210 tablets a month, and that runs $99,330.

5. Myalept

A medication for treating leptin deficiencies in those with generalized lipodystrophy, Myalept costs approximately $4,213 per vial. If you use the standard 10 vials a month, that’s $42,137.

Myalept is also the only medication available for treating the condition, so those who suffer it have no other options for finding cost savings.

6. H.P. Acthar

Also called Acthar, H.P. Acthar is an approved treatment for multiple conditions including multiple sclerosis, rheumatoid arthritis, Lupus, certain ophthalmic conditions, and more. One vial of the medication has a price tag of around $38,892.

7. Juxtapid

A 28 capsule supply runs about $36,992, or $1,321 per dose. The medication treats those with homozygous familial hypercholesterolemia, a genetic condition that can lead to heart disease.

8. Firazyr

Another treatment for hereditary angioedema, though using a different approach, Firazyr costs around $32,468 a month, or over $10,822 per syringe.

9. Harvoni

Harvoni treats Hepatitis C, a condition with notoriously high treatment costs, is widely advertised on television. It is the first combination drug, which needs to be taken once per day, in the treatment category, and a 12-week course of the medication is common.

28 tablets of Harvoni cost $31,500, or $1,125 per tablet. Over 12 weeks that brings the total to $94,500.

10. Cuprimine

Cuprimine is proof that even older medications can cost a bundle. It was invented in the 1970s, but still costs over $261 per tablet today. In fact, the high price tag is so controversial, that it debates in Congress have occurred and an episode of Dirty Money, a Netflix show, covered the topic.

A treatment for Wilson’s disease, those taking the drug usually go through three tablets per day, one after every meal. That brings the monthly cost up to $31,426.

11. Sovaldi

Another Hepatitis C treatment that usually requires a 12-week course is Sovaldi. At $1,000 per tablet, a month’s supply is around $28,000. For a full course of treatment, that comes out to $84,000.

Would Your Insurance Cover Some of the Cost?

Whether an insurance company will cover some of the costs of any prescription varies dramatically. If your doctor recommends any of the medications above, it’s wise to contact your insurer to discuss your coverage.

Additionally, asking your physician for information about alternatives can also result in cost savings, depending on your condition or the availability of generics.

In some cases, lower cost options may not be available, or your insurance might not provide coverage. In those cases, you need to discuss your situation with your doctor. They may be aware of programs that can help offset some of the expense, though that isn’t a guarantee.

Often, when a physician prescribes a medication, there is sound reasoning behind it. While shouldering these high costs could be scary, if your health is at risk, you may need to follow your doctor’s advice.

 

Have you ever been startled by the high cost of some prescription drugs? Tell us about your experience in the comments below.

 

Looking for more great articles? Here are a few to get you started:

 

If you enjoy reading our blog posts and would like to try your hand at blogging, we have good news for you; you can do exactly that on Saving Advice. Just click here to get started.