CBD and Medicare: What the CMS Pilot Covers and What It Doesn't

Maybe you've heard that Medicare now "covers CBD." The real change is much narrower. The program, often called a "CBD pilot," is what CMS calls a beneficiary engagement incentive. We don't recommend products or doses.

At a glance

What the federal action is

Three documents fit together:

• The executive order. Executive Order 14370, signed by President Trump on December 18, 2025 (CMS press release 2026), directs HHS, the FDA, CMS and the NIH to develop research models using real-world evidence "to improve access to hemp-derived cannabinoid products in accordance with Federal law" (Executive Order 14370 2025). The order itself does not create a Medicare benefit or name a dollar amount.
• The CMS program. On April 1, 2026, CMS let organizations in certain Innovation Center models begin offering the BEI, saying it aligns with the order (CMS press release 2026). It lets participants consult with eligible patients about hemp products "to improve symptom control" and furnish such products worth up to $500 a year per patient (CMS BEI 2026).
• The FDA letter. On April 1, 2026, the FDA Commissioner wrote that the agency "does not intend to enforce" certain drug provisions against an oral hemp-derived CBD product provided through a Medicare program under the direction of the patient's treating physician, if it follows the dietary supplement framework, is not contaminated and is not packaged or labeled to appeal to children. This letter, addressed to two senior FDA officials, under the heading "FDA Enforcement Posture," describes how the agency plans to enforce the law (FDA 2026).

The BEI was added through the models' participation agreements, not a published regulation; a federal court noted that the CMS Innovation Center has never used notice-and-comment rulemaking for a voluntary model component (D.D.C. 2026). CMS says plainly: "This is not a Medicare coverage change," and it "does not make claims regarding the therapeutic value of these products" (CMS press release 2026).

Who is eligible

Organizations. Only participants in three models can offer it (CMS BEI 2026):

• ACO REACH, in which provider groups called accountable care organizations (ACOs) coordinate care for people with Original Medicare (CMS ACO REACH 2026);
• the Enhancing Oncology Model (EOM), a voluntary model for oncology practices treating Medicare patients who get chemotherapy for seven cancer types (CMS EOM 2026);
• LEAD, the successor to ACO REACH (CMS LEAD 2026).

An organization must elect the BEI, submit an implementation plan naming the specific products, dosing information, eligibility criteria and safeguards, get CMS approval, and send quarterly reports (CMS BEI 2026). At launch, five ACO REACH organizations had submitted plans for review (CMS press release 2026). As of November 3, 2026, the CMS BEI page did not list approved organizations (CMS BEI 2026).

Patients. Patients must be aligned to a participating organization that offers the BEI. Model rules generally include being 18 or older, not meeting the model's frailty exclusion, not having specified disqualifying conditions, and not being pregnant or breastfeeding. A physician must decide use is appropriate and document shared decision-making, including "a review of current medications and potential interactions." The disqualifying conditions are in model participation documents, not on the BEI page (CMS BEI 2026).

Which products qualify

CMS sets these program requirements (CMS BEI 2026):

• federally legal hemp-derived products with no more than 0.3% delta-9 THC;
• no inhaled products;
• no oral products with more than 3 mg per serving of THC-type compounds, such as delta-8 THC or THCA;
• no cannabinoids the cannabis plant doesn't produce naturally;
• compliance with state and local law, and third-party testing for potency, contaminants and microbes.

So these products can contain some THC, which matters if you are drug tested (drug tests). Our guide to reading labels explains lab certificates.

How a patient would get it

A qualified physician affiliated with the participating organization must furnish the products directly; the organization handles buying and storing them. Patients should not be asked to submit a Medicare claim, and participants cannot tell patients to buy retail products and send in receipts (CMS BEI 2026). CMS says the BEI is "funded entirely at the participant's expense" (CMS ACO REACH 2026). Participants may not market it to get patients to choose or stay with them (CMS BEI 2026).

Is it available in my state? In 2026, the 74 ACO REACH organizations served people in all 50 states, DC and Puerto Rico, but the BEI "is only available to participants in states where the eligible hemp products are considered legal" (CMS ACO REACH 2026). Ask your doctor's office whether it takes part. State rules: CBD laws by state.

How long? ACO REACH's last performance year is 2026 (CMS ACO REACH 2026), EOM ends June 30, 2030 (CMS EOM 2026), and LEAD runs from January 1, 2027, through December 31, 2036 (CMS LEAD 2026). We found no separate end date for the BEI itself.

What it does not mean

• No general CBD coverage. The BEI "is not available to all Medicare beneficiaries," and CMS "will not pay for or reimburse providers for these products" (CMS press release 2026).
• Part D doesn't pay for over-the-counter products. A Medicare drug plan generally "only covers prescription drugs and won't pay for over-the-counter drugs" (Medicare.gov 2020); CMS's manual says a Part D drug "does not include OTCs" (CMS Part D manual 2016). Apart from Epidiolex, no CBD drug product is FDA-approved (FDA Q&A 2024).
• Medicare Advantage extras are limited. CMS's April 2026 final rule bars "cannabis products that are illegal under applicable State or Federal law" as special supplemental benefits for the chronically ill; at that time, CMS said, only hulled hemp seed, hemp seed protein powder and hemp seed oil qualified. It applies to coverage from January 1, 2027 (CMS final rule 2026).
• Epidiolex is separate. It is a prescription CBD solution for seizures linked to Lennox-Gastaut syndrome, Dravet syndrome or tuberous sclerosis complex in patients 1 year and older (Epidiolex label 2026). CMS states it "is covered under Medicare Part D" (CMS final rule 2026). Plans cover drugs on their formulary (drug list) unless an exception is granted, so check yours (Medicare.gov 2020).

How the 2026 hemp law changes fit in

Public Law 119-37 rewrites the federal hemp definition, including a limit of 0.4 mg total THC per container for final hemp-derived cannabinoid products (Pub. L. 119-37). Public Law 119-103 split its start date (Pub. L. 119-103):

• From November 12, 2026, only the part on cannabinoids the plant cannot produce naturally applies; the BEI already excludes those (CMS BEI 2026).
• Starting December 11, 2026, unless Congress delays it again, the rest applies, including the per-container limit (Pub. L. 119-103).

By our reading, an oral product with 3 mg of THC per serving, which the BEI definition on CMS's page (last modified March 20, 2026) allows, would be over that per-container limit. CMS has not said this itself; it says that if legal limits change, "as with Section 781," it "will adjust its definition in accordance with the law" (CMS BEI 2026).

Both laws are enacted statutes. Details: what changes and when.

Why this matters for older adults

In 2015–2016, 85% of US adults aged 60 and over had used a prescription drug in the past 30 days, according to a national survey (NCHS 2019). The executive order notes that nearly 15% of seniors reported using CBD in the past year; its warning about seniors "who may be on multiple medications" concerns medical marijuana use not discussed with a provider, not CBD (Executive Order 14370 2025).

Drug interactions. The Epidiolex label lists liver enzymes, such as CYP3A4 and CYP2C19, through which CBD can affect other medicines or be affected by them (Epidiolex label 2026). A review listed reported interactions with seizure medicines, antidepressants, opioids, acetaminophen and alcohol (Balachandran 2021). For blood thinners, a systematic review found evidence only for warfarin: seven case reports, with the INR (a clotting test) rising in six; in all of them the THC or CBD amounts were very high or unknown (Smythe 2023). In contrast, an analysis within a randomized trial of CBD oil in advanced cancer found CBD did not raise the chance of side effects among people taking other medicines, at least short term (Downs 2026).

Strength of evidence: low to very low. The warfarin data are case reports; the reassuring trial analysis was short-term and used indirect measures. Check your medicines with our drug interaction tool, and see blood thinners and warfarin.

Drowsiness and falls. In a meta-analysis of 12 randomized trials (803 participants), CBD was linked to more somnolence and sedation than placebo only in childhood epilepsy studies, where it may have interacted with other seizure medicines (Chesney 2020). The Epidiolex label says alcohol and other central nervous system depressants could add to its sedating effect (Epidiolex label 2026). We did not find a study that looked specifically at CBD and falls in older adults.

Strength of evidence: moderate for sedation alongside other seizure medicines; low for older adults, who were rarely studied. See also CBD for older adults.

Questions and criticism

Organizations that oppose cannabis legalization, individual plaintiffs and a company developing cannabinoid drugs sued HHS and CMS (Smart Approaches to Marijuana v. Kennedy). They argued that CMS skipped required procedures, acted arbitrarily, exceeded its authority and conflicted with the 2026 agriculture appropriations law. The federal court in Washington, DC, denied a temporary restraining order on March 31, 2026, and on May 22, 2026, dismissed the case because the plaintiffs had not shown standing (an injury that allows them to sue); it did not rule on whether the program is lawful (D.D.C. 2026). Some plaintiffs appealed to the DC Circuit on June 5, 2026 (Notice of appeal 2026). We could not find an appeals court ruling as of November 3, 2026.

CMS describes the BEI as including physician oversight, product standards and program integrity safeguards, and says it will monitor and evaluate outcomes (CMS press release 2026). We did not find published evaluation results.

When to talk to a doctor or pharmacist

Talk to your doctor or pharmacist before trying any CBD product if you take a blood thinner, seizure medicine, sleep or anxiety medicine, opioid, or several prescriptions; if you have liver disease; or if you have fallen or feel unsteady. If your doctor's office offers the BEI, ask which product it uses, how much THC it contains and how you will be followed. If you notice unusual drowsiness, confusion, bruising or bleeding, contact your care team.

Frequently asked questions

References