If you’ve ever lived with pain that just won’t quit, you’re not alone.
According to a Centers for Disease Control and Prevention report, chronic pain affected 51.6 million Americans in 2021, making it significantly more common than diabetes, depression and high blood pressure.
But what’s the difference between pain that you might experience for a few days and chronic pain? Pain is classified as chronic when it persists for more than three months and begins to interfere with everyday life, such as sleep, work or spending time with others.
“Chronic pain can be tricky to define in some cases. However, there are also some conditions, such as arthritis or fibromyalgia, that cause chronic pain and do not have a timeline,” says Dr. Kelsey Sicker, a family medicine physician with OhioHealth Physicians Group and associate program director for the Riverside Methodist Family Medicine Residency Program in Columbus, Ohio.
While chronic pain can significantly affect the quality of life of the millions of Americans who suffer from it, there are resources available through Medicare.
Medicare offers comprehensive coverage options for chronic pain management and related health issues to help beneficiaries manage pain and improve their well-being.
[READ: What Not to Say to People With Chronic Pain — and What to Say Instead]
What Parts of Medicare Cover Chronic Pain Management?
Depending on the type of treatment needed, coverage for chronic pain management comes from different parts of Medicare.
Part A (hospital insurance)
Part A does not cover chronic pain management on an ongoing basis. However, it can cover certain inpatient treatments where chronic pain is addressed during a stay at a hospital, skilled nursing facility or during hospice care.
Part B (medical insurance)
Most benefits related to chronic pain management are provided through Part B.
It covers a broad range of outpatient chronic pain management services, such as physical therapy and chiropractic care, and some medications administered by your doctor.
“Since chronic pain can affect mental health, Medicare Part B includes coverage for behavioral health services like depression screenings and care coordination,” says Dr. Patricia Pinto-Garcia, a board-certified pediatrician and medical editor at GoodRx. “It also provides coverage for alcohol misuse screenings and counseling, recognizing that long-term pain can sometimes contribute to substance use disorder.”
Part B costs will depend on your monthly premium, if you have satisfied your deductible and how many visits you incur. The standard monthly premium for beneficiaries is $185, but it may be higher depending on your income. The yearly deductible in 2025 for Part B is $257 after which your coinsurance of 20% per covered service kicks in.
Part C (Medicare Advantage)
Part C, also known as Medicare Advantage, must offer all benefits that original Medicare (Parts A and B) does and typically also provides some “extra” benefits.
Check with your Advantage plan to see what additional chronic pain management benefits your plan may offer, costs and if your plan’s drug formulary covers the medications your doctor recommends.
Part D (drug insurance)
Part D covers prescription medications — such as opioids, nonopioid pain relievers and other medications — used to manage chronic pain. It does not cover medications not in your plan’s formulary, so check before filling a prescription.
“Medicare Part D helps cover many commonly prescribed pain medications. Since prescription costs can vary between Part D plans, compare prices and identify potential savings on common pain medications,” Pinto-Garcia says.
While the 2025 Medicare Part D deductible cannot exceed $590, certain plans have no deductible. Also note there is a $2,000 annual cap on out-of-pocket prescription drug costs for Medicare Part D beneficiaries in 2025.
[READ: How Yoga Helps Reduce Acute and Chronic Pain]
What Services Are Covered Under Part B?
In many cases a combination of therapies is recommended to address the root causes of chronic pain.
In an outpatient setting, Part B covers the following services to help manage your pain and certain issues that may arise from having chronic pain:
— Acupuncture services. Part B covers up to 12 acupuncture treatments in a 90-day period for chronic lower back pain. Some Advantage plans may also cover acupuncture for other chronic pain conditions, such as chronic neck pain and migraines, according to Sicker, who is also an acupuncturist.
— Alcohol misuse screening and counseling. It provides coverage for alcohol misuse screening in those who consume alcohol but are not diagnosed with alcohol dependence. Patients may receive up to four brief, face-to-face counseling sessions annually.
— Behavioral health integration services. Medicare may pay for your provider to manage your behavioral health conditions, such as depression and anxiety.
— Chiropractic services. It covers chiropractic services to correct spinal joint movement issues that cause pain.
— Chronic pain management and treatment services. These may include pain assessments, care coordination, care planning and medication management.
— Depression screenings. Beneficiaries receive one depression screening per year.
— Mental health and substance disorder services. It covers screenings, services and programs for treatment and recovery.
— Occupational and physical therapy. There is no limit to occupational and physical therapy services in a calendar year.
— Opioid use disorder treatment services. It covers opioid use disorder treatment services in treatment programs.
Because Advantage plans must cover these services and more, depending on your plan, be sure to check your Advantage plan to determine what benefits you have access to.
[Read: 20 Drug Interactions You Should Know About]
Bottom Line
Living with chronic pain can be, well, a pain.
The kind of chronic pain management you need will determine which part of Medicare provides coverage and how much your out-of-pocket expenses will be.
If you’re dealing with chronic pain, not only should you talk with your doctor about available treatment options, but it’s important to ensure you are making full use of the pain management benefits your Medicare plan offers to help.
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Does Medicare Cover Chronic Pain Management? originally appeared on usnews.com
