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, 24.3% of adults experienced chronic pain in 2023, and 8.3% of adults had high-impact chronic pain.
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 it’s considered high-impact chronic pain when it 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 Physician Group in Hilliard, 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]
How to Be Eligible for Medicare Coverage for Pain
To be eligible for Medicare coverage for pain management, the following conditions must be met:
— The pain must be chronic (lasting for at least three months).
— The treatment must be medically necessary.
— The treatment must be provided by a Medicare-approved health care provider.
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 (SNF) 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:
— Pain management injections
— Medications (prescription pain relievers)
“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 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 Medicare Advantage plan to see what additional chronic pain management benefits your plan may offer, what costs you may need to pay 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.
[READ: How Yoga Helps Reduce Acute and Chronic Pain]
What Pain Management 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 Medicare 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. (Make sure that whoever is performing acupuncture is a recognized Medicare provider with additional training in acupuncture.)
— 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 Medicare Advantage plans must cover these services and more, depending on your plan, be sure to check your plan details to determine which benefits you have access to.
[READ: Does Medicare Cover Addiction Treatment and Rehabilitation?]
Cost of Pain Management Services With Medicare
According to Medicare.gov:
— For most pain management services, you pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible 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.
— You pay nothing for a yearly depression screening if your doctor or health care provider accepts assignment.
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 you should also ensure you are making full use of the pain management benefits your Medicare plan offers.
Find the Best Medicare Advantage and Medicare Part D Plans With U.S. News
Start your search for the right plan for you with U.S. News’ Best Medicare Advantage Plans and Best Medicare Part D Companies. You can also look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medicare supplement plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the Centers for Medicare & Medicaid Services and then adjusted for enrollment.
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Does Medicare Cover Chronic Pain Management? originally appeared on usnews.com
Update 01/21/26: This story was published at an earlier date and has been updated with new information.