If you have Medicare, there are covered options to help you manage pain safely and effectively.
Medicare covers prescription pain medications under Part D. In addition, Medicare Part B (medical insurance) helps pay for services that may help you manage your pain with less reliance on drugs, such as physical therapy, occupational therapy; manual manipulation of the spine (when medically necessary) and behavioral health services.
Part B helps pay for medically necessary outpatient physical therapy and outpatient occupational therapy. And, Medicare no longer limits how much it pays for medically necessary outpatient therapy services in one calendar year, so beneficiaries can get the number of visits they need.
Medicare does not cover other services or tests ordered by a chiropractor, including X-rays, massage therapy and acupuncture. (If you think your chiropractor is billing Medicare for chiropractic services that aren’t covered, you can report suspected Medicare fraud at https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/how-report-medicare-fraud.)
Besides a yearly depression screening, Medicare can also cover behavioral health integration services such as psychiatric collaborative care, and chronic and complex care management. Physicians, clinical psychologists, clinical social workers, nurse practitioners/specialists and physician assistants can provide inpatient treatment and professional services.
Prescription opioids like hydrocodone and oxycodone can be used effectively to help relieve moderate-to-severe pain. Your doctor may prescribe opioids following surgery or an injury, or for certain chronic health conditions.
These medications are an important part of treatment but they carry serious risks. If you’re using opioids for chronic pain, ask your doctor if you might also need a prescription for naloxone, an overdose-reversing drug that is covered by Medicare. Before starting or while taking opioids, talk with your doctor about all of your pain treatment options. Your doctor should tailor treatment according to your personal needs.
Some Medicare Part D drug plans have certain rules to help you use opioids safely. You can get more information on drug plan coverage rules at https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover/drug-plan-coverage-rules.
If you are in a Part D drug plan and take medications for different medical conditions, you may be eligible for a free medication therapy management program to help you and your doctor make sure that your medications are working to improve your health.
For most Medicare-covered pain management services, you pay 20 percent of the Medicare-approved amount for visits to your doctor or other healthcare provider to diagnose or treat your condition. The Part B deductible ($185 in 2019) applies.
If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.
For more information on safe and effective pain management, visit:
• Medicare, at https://www.medicare.gov/coverage/pain-management or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
• U.S. Department of Health and Human Services, at https://www.hhs.gov/opioids/prevention/pain-management-options/index.html.
• U.S. Centers for Disease Control and Prevention, at https://www.cdc.gov/drugoverdose/patients/options.html
• Administration for Community Living, at https://acl.gov/programs/addressing-opioid-crisis
Greg Dill is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).