Does Medicare Cover Pain Management for Its Enrollees?
- Does Medicare cover pain management? In some cases, yes. Keep reading to learn more about using your Original Medicare and Part D benefits for pain management.
Many medical conditions, including cancer, rheumatoid arthritis and fibromyalgia, cause chronic pain that can make it difficult to work, go to school and enjoy your hobbies. If your pain doesn't respond to a short-term course of treatment, you may need ongoing pain management to improve your quality of life. Pain management may include opioid medications, non-opioid medications and other treatments to reduce pain and make you more comfortable. Does Medicare cover pain management? In many cases, yes, but it depends on what benefits you have.
Does Medicare Cover Pain Management Under Part B?
Original Medicare has two parts: Part A, which covers hospital care, and Part B, which covers the services you receive as an outpatient. Your Part B benefits may pay for services you need to relieve pain or address a substance use disorder related to your pain. If you want Medicare to cover these services, they must be provided by a professional who participates in the Medicare program.
Physical and Occupational Therapy
Physical therapy is one of the non-medication treatments used to relieve pain. During a physical therapy session, your therapist may guide you through exercises designed to stretch your muscles or strengthen painful joints. Many physical therapy practices also offer heat therapy and other services to reduce pain without the use of opioids or other pain medications. For physical therapy, you can expect to pay 20% of the Medicare-approved amount of each service once you've paid your Part B deductible. In 2021, the Part B deductible is $203.
Occupational therapists support adults who are going through physical changes that may make it difficult to work or perform other activities of daily living. If you see an occupational therapist, you'll work with them to set goals and regain some of the skills you've lost due to your chronic pain. Medicare covers 80% of the Medicare-approved amount for occupational therapy services, leaving you to pay the other 20% once your deductible has been met.
If one of the bones in your spine moves out of the proper position, it can cause ongoing pain. This is known as a subluxation. Although Medicare doesn't cover many of the services provided by chiropractors, it does cover manual manipulation of the spine to treat subluxation and relieve pain. Under Part B, you pay 20% of the Medicare-approved amount for spinal manipulation services.
Psychotherapy is one of the non-medication approaches used to treat pain. When you work with a psychotherapist, you'll have the opportunity to modify your emotions and behaviors, which can help relieve pain even without the use of medications or other treatments. A therapist can also help you adjust your thinking patterns, changing the way you perceive pain and helping you feel more comfortable. Medicare Part B typically covers 80% of the Medicare-approved amount for seeing a psychotherapist.
Does Medicare Cover Pain Management Under Part D?
Does Medicare cover pain management under Part D? Most Medicare Prescription Drug Plans (Part D) offer some sort of coverage for drugs designed to help with pain management.
Medication management can help you avoid overdosing on pain medicines or taking medications that can cause harmful interactions when used at the same time. If you decide to try medication management, you and your doctor will work together to come up with an accurate list of your medications. The list will include the name of each medication, how often you should take it and how much you should take each time. If you have a Medicare drug plan, you may qualify for free medication management services.
Your doctor may recommend opioids or other pain medications to reduce your pain and make it easier to work and perform other activities. If you have Medicare Part D, your plan may cover these medications, but the level of coverage varies based on which plan you select. Unlike Original Medicare, Medicare Part D plans are offered by private insurance companies. Depending on where you live, you may have anywhere from 25 to 35 plans available. Each plan has its own formulary, which is a list of brand-name and generic drugs covered by the plan. In addition to the monthly premium for your Part D plan, you may also have to pay a copay each time you fill a prescription for your pain medication.
Because opioid medications can be addictive, some plans require prior authorization before covering them. Medicare also requires pharmacists to perform safety checks when filling prescriptions for opioid medications, limits the number of pills you can receive at one time and recommends tapering to help you withdraw safely when you're ready to stop using opioid medications.
Services Medicare Doesn't Cover
Although massage therapy has many benefits, it isn't covered by Medicare, even if you need it for pain relief. Your doctor may also recommend other services that aren't covered by Medicare. If you're on a tight budget and can't afford to pay the full cost of extra services, check with Medicare before trying new treatments. Call 1-800-MEDICARE to speak to a representative who can help you understand your Medicare benefits.