Pain Management: Medicare Coverage and How Much it Costs?

Pain Management: Medicare Coverage and How Much it Costs?

The word “pain management” can refer to a variety of things. For example, following surgery or an injury, some patients may require short-term pain management. Others may require long-term pain management due to illnesses such as arthritis, fibromyalgia, or other pain syndromes.

Because pain treatment can be costly, you may be wondering whether Medicare would pay for it. However, many of the therapies and services you’ll need for pain management are covered by Medicare.

To know more about what parts of Medicare cover particular therapies and services, the expected costs, and the various ways pain may be controlled, read on.

Medicare Coverage for Pain Management

Medicare covers many treatments and services required to manage pain. Here’s a rundown of the parts that discuss it and the covered treatments.

Part A

If you’re a patient in a clinic or a long-term care home, you may receive coverage for pain management under the following circumstances:

  • Had a surgery due to a catastrophic injury or a car accident
  • Need a therapy for a life-threatening disease (cancer, for example)
  • Need hospice (end-of-life) care

While you’re in the hospital, you may require a variety of services or therapies to help you manage your pain, including:

  • Medication for epidural or other spinal injections (both narcotic and non-narcotic)
  • Occupational therapy treatment
  • treatment for the body

Part B

Talking about Medicare Part B, here’s the following it will cover concerning pain treatment services:

  • Medication Administration: Part B may also cover prescribed drugs for pain management if it is required to administer the medication by the doctor in their office.
  • Physical Therapy: If your doctor prescribes you a type of treatment that involves physical therapy to help you manage your pain, whether it’s acute or chronic, then Part B will cover it.
  • Occupational Therapy: It is a term used to describe a type of therapy treatment. This sort of therapy assists you in returning to your typical daily activities, which you may have been unable to accomplish due to accidents, surgeries, or injuries.

Here’s more about Occupational Therapy if you want to know more; Occupational Therapy: Does Medicare Cover It?

  • The manipulation of the spine: If a subluxation is medically required, Part B covers restricted physical manipulation of the spine.
  • Alcohol Testing and Counseling: Chronic pain can sometimes lead to drug misuse. Medicare also covers screenings and counseling.

Part C

Medicare Advantage or Part C offers the same benefits provided by Original Medicare (Part A & B) and some additional benefits.

However, the additional benefits may vary from plan to plan. Therefore, it is suggested to consult your plan provider to know what pain management services are available in additional benefits.

Part D

Part D (prescription drug coverage) of Medicare will assist you in paying for your prescriptions as well as services to help pain management. 

Medicare Part D. often covers Medication Therapy Management (MTM) programs. Opioid pain drugs such as hydrocodone (Vicodin), oxycodone (OxyContin), morphine, codeine, and fentanyl are frequently administered and covered under Prescription Drug Coverage or Part D.

How Much Does Pain Management Cost?

The cost may vary depending upon the services availed, and because different services are covered under different parts of Medicare, the OOP costs may also vary. Here’s a brief idea about the same.

Part A

Your hospital insurance is covered by Medicare Part A. You will be liable for the following charges under Part A while you are in the hospital:

  • Before coverage begins, each benefit period has a $1,556 deductible.
  • For the first 60 days, there will be no coinsurance.
  • For days 61 to 90 of each benefit period, there is a $389 coinsurance fee.
  • After day 90 of each benefit period, there is a $778 coinsurance fee.

Part B

You are liable for the following costs under Medicare Part B:

  • An annual deductible of $233 must be fulfilled each year before any medically essential procedures are provided.
  • In 2022, your monthly premium will be $170.10 for most people.
  • Prescription medication coverage is provided under Medicare Part D. Many of the medicines given for pain treatment are covered by Part D and some Medicare Part C/Medicare Advantage plans. These plans may also cover drug treatment management services if you have more complicated healthcare requirements.

Part C

The cost of a Medicare Part C plan will vary depending on your plan and its coverage. Under Part C cost, you have to pay the premium of the individual plan. 


Most Medicare plans include pain management treatments and services if recognized as medically necessary by a physician.

If you have a Medicare Advantage plan, the coverage may vary. Check with your insurance provider to see what is covered under your specific scenario.

Consult our licensed agents specializing in Medicare today if you need any help finding a suitable Medicare plan or cannot distinguish whether Part C or Original Medicare will be better for you.