Does Medicare Cover Pain Management?

Medicare may help cover pain management services or treatment, depending on your specific situation.

A Medicare Advantage (Part C) would also help cover pain management services if they would otherwise be covered by Medicare Part A hospital insurance and/or Part B medical insurance.

How much does Medicare pay for pain management?

There isn’t one standardized way in which Medicare covers pain management. Chronic pain can be caused by several different conditions or injuries that require varying types of treatment.

Some treatment options related to chronic pain that Medicare may help cover include, but aren’t limited to:

• Physical therapy
• Medical procedures
• Pain medication (under Medicare Part D)

Does Medicare cover physical therapy?

Physical therapy can help ease chronic pain by targeting specific areas of weakness in the way your body works.

Medicare Part B sometimes pays for physical therapy when it is considered medically necessary and ordered by your doctor. There is typically an annual cap on the amount Medicare will cover in a single year.

Check with your doctor to find out if your physical therapy is covered by Medicare and how much you could potentially pay out of pocket.

If you have a Medicare Advantage plan, check with your plan carrier to find out if your plan offers any additional benefits related to physical therapy that aren’t offered by Original Medicare.

Does Medicare cover pain management medical procedures?

There are numerous medical procedures that may be covered by Medicare Part B, so long as the procedure is considered medically necessary.

Typically, Medicare Part B covers 80 percent of the Medicare-approved amount for covered doctor services. You typically pay 20 percent of the Medicare-approved cost after you meet your Part B deductible.

In 2019, the Part B deductible is $185 per year.

If your procedure is considered an inpatient procedure and requires a hospital stay, your hospital costs may be covered by Medicare Part A.

If your procedure is covered by Part A, your potential out-of-pocket costs include:

• Part A deductible: $1,364 per benefit period in 2019
  
  
• Part A coinsurance:
• Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
• Days 61-90: $341 coinsurance per day of each benefit period in 2019
• Days 91 and beyond: $682 coinsurance per each lifetime reserve day after day 90 for each benefit period in 2019
• Beyond lifetime reserve days: you pay all costs

Does Medicare cover pain medication?

Original Medicare does not cover most prescription drugs, including medications to help with chronic pain.

If you’re enrolled in Medicare Part A and Part B and need coverage for prescription drugs, you typically have two options:

• Enroll in a Medicare Prescription Drug Plan (Medicare Part D)
• Enroll in a Medicare Advantage plan (Medicare Part C) that includes Part D prescription drug coverage

Part D plans are stand-alone plans that are sold by private insurance companies to help cover some prescription drug costs.

Medicare Advantage plans are sold as an alternative to Original Medicare and usually lump your Part A, Part B and prescription drug benefits together in one convenient plan.

A standalone Part D plan or Medicare Advantage plan with drug coverage will each include a drug formulary. This is a list of medications your plan will cover. If you take prescription medications for chronic pain, consult the plan formulary to see if it will be covered.

Some Medicare Advantage plans also offer additional benefits, which may include but aren’t limited to:

• Routine dental coverage and vision coverage
• Hearing coverage
• Health and wellness program benefits such as SilverSneakers membership

Find Medicare Advantage plans in your area

A licensed insurance agent can help you find Medicare Advantage plans in your area. They can help you learn about what services and prescription drugs might be covered by Part C plans where you live.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.