Is Chronic Pain Management Included In Medicare Coverage?

If you’ve experienced persistent pain that doesn’t go away, you’re not isolated in that struggle. Data from the Centers for Disease Control and Prevention indicates that in 2021, 51.6 million adults in the United States dealt with chronic pain. This condition is notably more prevalent than other common health issues like diabetes, high blood pressure, and depression

But how does occasional pain differ from chronic pain? Pain is generally considered chronic when it lasts for more than three months and starts to disrupt daily activities, such as sleeping, working, or socializing. Defining chronic pain can sometimes be complex. However, certain medical conditions, like arthritis or fibromyalgia, are known to cause chronic pain without a specific time limit.

Chronic pain can greatly diminish the quality of life for the many Americans who live with it. Fortunately, resources are available through Medicare. Medicare provides extensive coverage options for managing chronic pain and addressing related health concerns, aiming to help beneficiaries control their pain and enhance their overall well-being.

Which Medicare Parts Help Pay for Chronic Pain Treatment?

The Medicare coverage for managing chronic pain varies depending on the specific type of treatment required and falls under different parts of the program.

Hospital Insurance (Part A)

Medicare Part A generally doesn’t cover continuous chronic pain management on an outpatient basis. However, it can provide coverage for certain treatments received during an inpatient stay in a hospital, a skilled nursing facility, or as part of hospice care, where chronic pain is addressed during that stay.

Medical Insurance (Part B)

For individuals dealing with ongoing pain, Medicare Part B provides significant support. This part of Medicare helps pay for a variety of outpatient services aimed at managing chronic pain. These can include treatments like physical therapy sessions and chiropractic adjustments. It also covers certain medications that your doctor administers directly to you.

Recognizing that persistent pain can affect mental well-being, Part B also includes benefits for behavioral health. This means services like screenings to check for depression and assistance in coordinating your overall care are covered. Additionally, because long-term pain can sometimes lead to issues with substance use, Part B offers coverage for screenings related to alcohol misuse and counseling services.

When it comes to the costs associated with Part B, several factors come into play. Your expenses will be determined by your monthly premium, whether you have met your annual deductible, and how frequently you use covered services. The typical monthly premium for beneficiaries is $185, though this figure can increase for those with higher incomes. Looking ahead to 2025, the yearly deductible for Part B is set at $257. Once you have paid this deductible amount, you will generally be responsible for 20% of the cost for each covered service you receive (this is known as coinsurance).

Medicare Advantage (Part C)

Medicare Part C, often referred to as Medicare Advantage, are managed by private insurance companies approved by Medicare. A key requirement for Medicare Advantage plans is that they must offer, at a minimum, all the same benefits that are provided under Original Medicare.

Many Medicare Advantage plans also include additional perks not found in Original Medicare. If you have chronic pain and are enrolled in a Medicare Advantage plan, it’s a good idea to contact your plan provider directly. You’ll want to ask about any specific extra benefits they offer for managing long-term pain. Also, inquire about the costs associated with these services and, importantly, check if the specific medications your doctor recommends are covered under your plan’s list of approved drugs

Prescription Medication Insurance (Part D)

Medicare Part D is the part of Medicare that helps cover the cost of prescription medications. This is particularly relevant for chronic pain management, as it can include coverage for various medicines such as opioids, pain relievers that are not opioids, and other drugs prescribed to help manage persistent pain.

While some Part D plans might not require you to pay a deductible at all, the maximum annual deductible for any Part D plan cannot be more than $590. Furthermore, an important update for 2025 is that there will be a $2,000 yearly limit on the amount Medicare Part D beneficiaries have to pay out-of-pocket for their covered prescription drugs.

What Chronic Pain Services Are Included Under Medicare Part B?

Managing long-term pain often requires a multifaceted approach, using several types of therapies to get to the heart of the problem. Through Medicare Part B, you can access a variety of outpatient services designed to help control your pain and address some of the health issues that can arise from living with chronic pain.

• Acupuncture for Lower Back Pain: Up to 12 acupuncture sessions over a 90-day period specifically for chronic lower back pain. It’s worth noting that some Medicare Advantage plans might offer broader acupuncture coverage for other ongoing pain issues like persistent neck pain or migraines, according to insights from Sicker, who is also an acupuncturist.
• Support for Alcohol Use: For individuals who consume alcohol but are not considered alcohol dependent. Includes screenings for alcohol misuse. If needed, patients can receive up to four brief, in-person counseling sessions each year.
• Integrated Behavioral Health Care: Medicare may help pay for your healthcare provider to oversee and manage related behavioral health conditions which can often accompany chronic pain, such as depression or anxiety.
• Chiropractic Adjustments: Coverage extends to chiropractic services that aim to correct issues with spinal joint movement which are causing pain.
• Comprehensive Chronic Pain Care: Covers specific services focused on managing and treating chronic pain. These can include detailed pain assessments, coordination of your overall care, development of a personalized care plan, and help with managing your medications.
• Depression Checks: Beneficiaries are entitled to one depression screening annually.
• Broader Services: Helps cover screenings, various services, and programs dedicated to treating mental health conditions and substance use disorders, supporting recovery.
• Opioid Use Disorder Treatment: For those facing opioid use disorder, Part B covers treatment services when received through approved treatment programs.
• Physical and Occupational Therapy: There’s no annual cap on the amount of occupational and physical therapy services you can receive, allowing for ongoing support as needed.

Conclusion

Dealing with long-lasting pain can be really tough. The specific Medicare plan you have will determine what kind of chronic pain treatment is covered and how much you’ll end up paying yourself. If you’re experiencing ongoing pain, it’s a good idea to discuss treatment choices with your doctor and also to understand and utilize the pain management benefits included in your Medicare coverage.