Medical marijuana is not covered by insurance in New York. Private health plans, employer coverage, Medicaid, and Medicare all exclude cannabis products because marijuana remains a Schedule I controlled substance under federal law. Patients pay for the cannabis itself entirely out of pocket, though a few related costs — certain office visits, workers’ compensation claims, and FDA-approved cannabinoid prescriptions — follow different rules.
Why Insurance Won’t Pay for the Cannabis Itself
The block is federal. Under 21 U.S.C. § 812, marijuana sits in Schedule I, a category defined as having no accepted medical use and a high potential for abuse.1Office of the Law Revision Counsel. 21 USC 812 – Schedules of Controlled Substances The DEA groups it with heroin and LSD.2Drug Enforcement Administration. Drug Scheduling Because cannabis has not gone through FDA approval as a prescription drug, insurers have no regulatory basis to treat it like a covered medication, even though New York legalized medical use through the Compassionate Care Act and later expanded the program under the Marihuana Regulation and Taxation Act.3New York State Senate. New York Public Health Law Article 33 – Controlled Substances
New York’s Department of Financial Services stated the position directly in a 2017 circular letter: medical marijuana “is not a Food and Drug Administration-approved drug and remains a Schedule 1 Controlled Substance,” and insurers “are not required to cover the cost of medical marijuana under the Insurance Law.”4New York State Department of Financial Services. Insurance Circular Letter No. 6 (2017) The exclusion runs across every category of coverage — commercial plans, employer-sponsored plans, Medicaid, and Medicare.5New York State Senate. New York State Senate Bill 2023-S2568
The Office Visit May Still Be Covered
The product isn’t covered. The appointment where you get certified often is. DFS guidance requires insurers to cover an office visit that results in a medical marijuana certification, as long as the visit also included other covered services and wasn’t held solely to obtain the certification.6Department of Financial Services. DFS Reminds Health Insurers of Their Obligation to Cover Office Visits that Also Include Medical Marijuana Certification Among Other Healthcare Services An insurer cannot deny the whole claim just because a certification came out of it.4New York State Department of Financial Services. Insurance Circular Letter No. 6 (2017) New York’s Office of Cannabis Management has confirmed that these visits are Medicaid-reimbursable for participating practitioners.7Office of Cannabis Management. Policy Clarification – Medical Cannabis Office Visits
A standalone appointment whose only purpose is getting a certification can fall outside coverage. If that’s what you’re scheduling, check with your insurer first. Many patients raise the topic during a regular follow-up for the qualifying condition instead.
Workers’ Compensation Is the Real Exception
Workers’ compensation follows its own rules, and a 2021 New York appellate ruling settled that carriers can be required to reimburse injured workers for medical marijuana. In Matter of Quigley v. Village of East Aurora, the court looked at whether the Compassionate Care Act’s insurer exemption reached workers’ comp carriers.8Justia Law. Matter of Quigley v Village of E. Aurora
It did not. The exemption named the Public Health Law, the Insurance Law, and the Social Services Law, but not the Workers’ Compensation Law. Because Workers’ Compensation Law § 13(a) requires employers to pay for medical treatment the nature of the injury requires, carriers must reimburse claimants for medical marijuana when a treating physician has authorized it. The court also held that federal drug law didn’t preempt this obligation: reimbursing a purchase isn’t the same as manufacturing or distributing a controlled substance.8Justia Law. Matter of Quigley v Village of E. Aurora If you’re using medical cannabis for a workplace injury, the carrier may be required to cover it. Expect pushback and delays.
FDA-Approved Cannabinoid Drugs Insurance Does Cover
A short list of prescription medications derived from or related to cannabis moves through the normal insurance channel because the FDA has approved them. Epidiolex, a cannabidiol oral solution, is approved for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex in patients one year and older. Dronabinol (Marinol, Syndros) and nabilone (Cesamet) are approved for chemotherapy-related nausea, with dronabinol also approved for appetite loss associated with AIDS. These are handled like any other prescription drug, with standard copays and prior authorization where applicable. If a cannabinoid therapy might help your condition, ask your doctor specifically about these options; the coverage picture is entirely different from dispensary cannabis.
HSA, FSA, and Medical Expense Deductions Don’t Apply
The federal problem reaches your tax-advantaged accounts too. You cannot use an HSA or FSA to pay for medical marijuana. IRS Publication 502 is explicit: “You can’t include in medical expenses amounts you pay for controlled substances (such as marijuana) that aren’t legal under federal law, even if such substances are legalized by state law.”9Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses The same rule keeps cannabis purchases out of an itemized medical expense deduction on your federal return. Every dollar spent on medical cannabis comes from after-tax income with no tax benefit attached.
What You’ll Actually Pay
New York has eliminated the patient registration fee for the medical cannabis program, so certification carries no state fee. A physician evaluation through a dedicated certification service typically runs $100 to $250, though costs vary. If the evaluation happens inside a regular covered visit for your qualifying condition, your only cost may be your usual copay.
Product costs are where the money goes. At New York dispensaries, flower generally runs $40 to $60 for an eighth of an ounce, vape cartridges $45 to $90 for a half gram, and tinctures $55 to $90 for a 30-milliliter bottle. Edibles average around $70 for a 100-milligram package. Monthly spending depends on condition, dosage, and product preference, but most patients should plan for at least several hundred dollars a month. New York also imposes an excise tax on medical cannabis sales, which lifts the shelf price further.
What Could Change
Two things are moving. At the state level, Senate Bill S2568 would reclassify medical marijuana as a “prescription drug” for Medicaid, the Elderly Pharmaceutical Insurance Coverage (EPIC) program, and workers’ compensation, and would let the state certify dispensing sites as Medicaid providers.5New York State Senate. New York State Senate Bill 2023-S2568 As of early 2026, the bill remains in the Senate Health Committee. A companion pairing, Senate Bill S6549 and Assembly Bill A4744, addresses similar coverage questions in the current session.
At the federal level, the Department of Justice and DEA proposed rescheduling marijuana from Schedule I to Schedule III in May 2024, and a December 2025 executive order directed the Attorney General to expedite the process. No final rule had issued as of early 2026.10Congress.gov. Legal Consequences of Rescheduling Marijuana If marijuana moves to Schedule III, it would lose the “no accepted medical use” label, which is the single biggest legal obstacle to insurance coverage. Rescheduling alone would not create coverage overnight, but it would open a path that has been closed for decades.