According to a recent article by Marijuana Moment, the United States government has made final a rule allowing specific hemp products to be offered with coverage based on the Medicare Advantage plan.
Based on the ruling, products that are legal federally as well as at the state level can be reimbursed, which is a huge step forward, given that older policies prevented all cannabis-based substances from being reimbursed by insurance. However, we must be careful to take note of the nuances here; the ruling doesn’t treat cannabis as a primary medical treatment just yet but rather they are considered “specialized, non-primarily health-related benefits” by the Centers for Medicare and Medicaid Services (CMS).
These fall under the Special Supplemental Benefits for the Chronically Ill (SSBCI) program.
The phrasing enables the government to expand insurance access without the risk of blatantly endorsing cannabis, or referring to it as mainstream medicine just yet. The new policy’s coverage is based on the Food and Drug Administration’s ruling that some cannabis hemp food products are GRAS (generally recognized as safe), and they have met the standard of being a “reasonable expectation of improving or maintaining the health or overall function”.
Requirements
Based on the 2018 Farm Bill, hemp products are considered legal if they contain under 0.3% delta-THC according to its dry weight. But the new rule, which takes effect in November, tightens these standards further; it will mean that any product containing over 0.4 milligrams of THC in each container will be considered illegal, regardless of percentage.
The new regulations will then allow Medicare Advantage (MA) to offer some hemp-derived products, such as hemp protein powder, hulled hemp seeds, and hemp seed oil as a supplemental benefit. Currently, these are the only three types of products that are allowed according to the current laws. They must comply with FDA safety regulations as well as any other applicable laws.
By November 12, 2026, cannabis hemp products that do not need the new hemp definitions will be prohibited and considered illegal, unless there are changes to the federal law.
“The amended language also clarifies that MA organizations remain prohibited from covering any cannabis product, including any hemp-derived cannabis product, that is illegal under state law within their service area regardless of the product’s federal legal status,” reads the new ruling.
Pilot Programs For Data Gathering
Last March 2026, CMS launched a pilot-style program following its innovation model where some doctors are allowed to recommend hemp-based products including CBD. This is nowhere near traditional insurance coverage due to the restrictions stating that patients are not allowed to purchase the CBD themselves then get reimbursed, but instead, doctors in certain programs provide the products themselves, worth as much as $500 per year.
There are still many restrictions, since not all Medicare plans cover them, and they are only available through participating models. Doctors must also only give a controlled dose while supervising them and collecting data to measure safety and efficacy. Furthermore, no inhabitable products are allowed.
Additionally, there is a project called the Substance Access Beneficiary Engagement Incentive, which already integrates hemp products into care, while focusing on symptom management and tracking outcomes.
The Center for Medicare and Medicaid Innovation (CMMI) is running these experimental models to test various new ideas before they are rolled out nationwide.
What Happens If Cannabis Is Rescheduled?
The CMS also addressed public comments that were raised regarding the possible rescheduling of marijuana; after all, US President Trump earlier directed that this must be completed as soon as possible.
The agency said that if cannabis is moved to Schedule III, the reclassification within the Controlled Substances Act would indeed change. This shift alone wouldn’t be enough to automatically make cannabis products viable as a supplemental benefit, since to quality, they would still need to undergo further vetting to ensure they comply with state and federal laws.
Limitations
There are still serious limitations to the current and upcoming framework, so it’s important to note that Medicare isn’t covering CBD as a benefit.
CBD, unfortunately, is still in a gray area where it’s being allowed in pilots and currently being evaluated on a case-to-case basis. It is also not recognized as therapeutic by the public - just yet!
It’s also critical to know that medical marijuana is not covered yet, and any product with more than 0.3% delta THC is still illegal. After all, Medicare is a federal program, so they will never cover illegal substances.
Conclusion
As of today, the CMS policy is still against marijuana in general.
But let’s not overlook the good news which is that they’ve already recognized the health benefits of hemp, particularly with non-intoxicating hemp food and through pilot-based CBD access. While the US isn’t yet at the stage where Medicare fully covers THC and CBD medications, there is a clear transition towards restricted yet evidence-based acceptance of hemp-based cannabinoids.
These new developments may look like a breakthrough, we should take it as a controlled shift in policy for now. But through the pilot programs, defined product categories, and limited benefits, CMS and other agencies are still gathering the data that they need in order to make more final decisions regarding the integration of cannabis into insurance and healthcare.
In other words, this isn’t a time yet when cannabis becomes accepted as part of mainstream healthcare. It’s just another albeit important step in the evaluation process. More importantly, there are policies being put in place that will lay the groundwork for what becomes a more important shift.
MEDICARE AND MEDICAL CANNABIS, READ ON...
