- Medicare covers several different therapies and services used in pain management.
- Medications that manage pain are covered under Medicare Part D.
- Therapies and services for pain management are covered under Medicare Part B.
- Medicare Advantage plans also typically cover at least the same medications and services as parts B and D.
The term “pain management” can include many different things. Some people may need short-term pain management after a surgery or an injury. Others may need to manage long-term chronic pain for conditions like arthritis, fibromyalgia, or other pain syndromes.
Pain management can be expensive so you may be wondering if Medicare covers it. Medicare does cover many of the therapies and services you’ll need for pain management.
Read on to learn which parts of Medicare cover different therapies and services, costs you can expect, and more about the many ways pain can be managed.
Medicare provides coverage for many treatments and services that are needed to manage pain. Here is an overview of the parts that cover it and what treatments are included.
Medicare Part B
- Medication management. Prior approval may be needed before you can fill narcotic pain medications. You may also be given a limited quantity.
- Behavioral health integration services. Sometimes, people with chronic pain can also have problems with anxiety and depression. Medicare covers behavioral health services to help manage these conditions.
- Physical therapy. For both acute and chronic pain issues, physical therapy may be prescribed by your doctor to help manage your pain.
- Occupational therapy. This type of therapy helps get you back to your normal daily activities that you may not be able to do while in pain.
- Chiropractic spinal manipulation. Part B covers limited manual manipulation of the spine if medically necessary to correct a subluxation.
- Alcohol misuse screenings and counseling. Sometimes, chronic pain can lead to substance abuse. Medicare covers screenings and counseling for this as well.
Medicare Part D
Medicare Part D (prescription drug coverage) will help you pay for your medications and programs to manage them. Medication therapy management programs are covered and can offer help navigating complex health needs. Often, opioid pain medications, such as hydrocodone (Vicodin), oxycodone (OxyContin), morphine, codeine, and fentanyl, are prescribed to help relieve your symptoms.
You may receive pain management if you’re an inpatient at a hospital or long-term care facility for the following reasons:
- car accident or major injury
- treatment for a serious illness (cancer, for example)
- end-of-life (hospice) care
While you’re admitted to the hospital, you may need several different services or therapies to manage your pain, including:
- epidural or other spinal injections
- medications (both narcotic and non-narcotic)
- occupational therapy
- physical therapy
Eligibility for coverage
To be eligible for coverage, you must be enrolled in either an original Medicare plan or a Medicare Part C (Medicare Advantage) plan. Your hospital stay must be deemed medically necessary by a doctor and the hospital must participate in Medicare.
Medicare Part A costs
Medicare Part A is your hospital insurance. While you are admitted to the hospital, you will be responsible for the following costs under Part A:
- $1,408 deductible for each benefit period before coverage kicks in
- $0 coinsurance for each benefit period for the first 60 days
- $352 coinsurance per day of each benefit period for days 61 to 90
- $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- 100 percent of costs beyond your lifetime reserve days
Medicare Part C costs
Costs under a Medicare Part C plan will be different and will depend on which plan you have and how much coverage you’ve chosen. The coverage you have under a Part C plan must be at least equal to what original Medicare covers.
Some forms of outpatient pain management are also covered under Medicare Part B. This includes things like:
- medication management
- manipulation of the spine, if medically necessary
- outpatient injections (steroid injections, epidural injections)
- transcutaneous electrical nerve stimulation (TENS) for pain after a surgical procedure
- autogenous epidural blood graft (blood patch) for headaches after an epidural or spinal tap
Eligibility for coverage
Before these services and procedures are covered, a Medicare-enrolled doctor must certify that they are medically necessary to treat your condition.
Medicare Part B costs
Under Medicare Part B, you are responsible for paying:
- An $198 annual deductible, which must be met each year before any medically necessary services will be covered
- Your monthly premium, which is $144.60 for most people in 2020
Medicare Part D provides prescription drug coverage. Both Part D and some Medicare Part C/Medicare Advantage plans cover many of the drugs that may be prescribed for pain management. These plans may also cover medication therapy management programs if you have more complex healthcare needs.
Common medications that may be used in pain management include, but are not limited to:
- narcotic pain medicines like Percocet, Vicodin, or oxycodone
- gabapentin (a nerve pain medicine)
- celecoxib (an anti-inflammatory medication)
These medications are available in generic and brand name forms. The medications that are covered will depend on your particular plan. Costs will vary from plan to plan, as will the coverage amounts for different drugs. The costs will depend on your individual plan’s formulary, which uses a tier system to group drugs into high, middle, and lower costs.
It’s important to go to a participating healthcare provider and pharmacy to get your prescriptions for Medicare Part D. For Part C, you must use in-network providers to ensure full benefits.
A note on narcotic pain medications
Your healthcare provider should give you a wide range of options to treat your pain, not just narcotic medications. With the increase in opioid overdoses in recent times, a greater emphasis is being placed on safe narcotic use.
It might be worth getting a second opinion to see if other non-narcotic options, like physical therapy, could help with your condition.
Over-the-counter (OTC) drugs
OTC medications that may be used for pain management include:
- lidocaine patches or other topical medications
Medicare Part D does not cover OTC medications, only prescription medications. Some Part C plans may include an allowance for these medications. Check with your plan about coverage and also keep this in mind when shopping for a Medicare plan.
Pain management includes treatments, therapies, and services that are used to treat acute and chronic pain. Acute pain is typically associated with a new illness or injury. Examples of acute pain include:
- pain after surgery
- pain after a car accident
- broken bone or ankle sprain
- breakthrough pain
Examples of chronic pain conditions include:
In addition to pain medicines and physical therapy, there are other methods for managing chronic pain. Many people find relief with the following therapies:
- acupuncture, which is actually now being covered under Medicare for people who have issues with lower back pain
- CBD or other essential oils
- cold or heat therapy
Most of these are not covered by Medicare but check with your particular plan to see if a therapy is covered.
- Pain management therapies and services are generally covered by most Medicare plans if they are certified as medically necessary by a healthcare provider.
- Medicare Advantage coverage may vary from plan to plan, so be sure to check with your insurance provider about what is covered under your particular plan.
- There are many other options to explore to manage pain aside from narcotic pain medications.