With a growing interest in natural remedies and a more holistic approach to health, many seniors are increasingly turning to acupuncture and other forms of alternative therapies to manage chronic pain and various health conditions.
As Medicare is the primary health insurance source for older adults in the U.S., understanding its coverage for alternative therapies is crucial to guiding informed health care decisions and ensuring your chosen treatments are financially feasible as you age.
Medicare Coverage for Acupuncture
Medicare generally doesn’t cover most types of alternative medicine, including acupuncture, but there are a few exceptions.
[Read: What Medicare Doesn’t Cover and How to Manage Costs]
What is acupuncture?
Acupuncture is a traditional Chinese medicine practice involving inserting thin needles into specific points on the body. It’s thought to stimulate the body’s natural healing processes and improve overall physical and mental health, including anxiety.
Acupuncture is commonly used to treat chronic pain conditions, such as back pain, neck pain and headaches, as well as a variety of conditions, such as allergies, digestive issues and insomnia.
Does Medicare cover acupuncture?
Yes, as of 2020, Part B under original Medicare covers a portion of the costs for acupuncture treatments under very specific circumstances:
— For chronic lower back pain
— Up to 12 acupuncture treatments
— Within 90 days
After you’ve met your Medicare Part B annual deductible, you’re responsible for covering 20% of the Medicare-approved costs of services and treatment.
If your chronic lower back shows signs of improvement after 12 treatments in 90 days, Medicare may cover an additional eight sessions; however, if you aren’t improving or are regressing after this time, then treatment must discontinue or you’ll be responsible for 100% of out-of-pocket costs moving forward. Medicare will cover a maximum of 20 treatments over a 12-month period.
[SEE: Things You Should Know About Medicare.]
Eligibility for acupuncture coverage
Not anyone with a nagging back pain qualifies for Medicare coverage. Medicare beneficiaries must meet the definition for chronic low back pain, characterized as:
— Duration: persisting for 12 or more weeks
— Cause: unknown or nonspecific — meaning it’s not related to a particular accident or as a result of pregnancy, surgery, an infection, an inflammatory disease or cancer
[READ: What Is Spinal Stenosis? Causes, Symptoms, Treatments and Prevention]
Who can administer acupuncture treatment for Medicare beneficiaries?
Only certain health care providers are authorized to provide acupuncture services under Medicare. To qualify for Medicare coverage, acupuncture must be performed by a doctor or provider who meets the following qualifications:
— Holds a master’s or doctoral degree in acupuncture or oriental medicine, and the school issuing a qualifying degree must be accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
— Has a current and active unrestricted license to practice acupuncture in the state, territory or commonwealth where care is provided
Even then, Medicare does not allow direct payment to licensed acupuncturists for services. If a licensed acupuncturist provides acupuncture treatments, this means they cannot directly bill Medicare and receive payment.
Licensed acupuncturists need to either work under the supervision of a Medicare-eligible health care provider or be employed by an eligible provider who can bill Medicare for the services, ensuring compliance with Medicare’s payment policies.
“One of the biggest problems with acupuncture is trying to find a Medicare-certified provider,” says Diane J. Omdahl, founder of 65 Incorporated, a Wisconsin-based company that helps people choose Medicare coverage.
She explains that most acupuncturists aren’t Medicare-certified because of the “hoops they have to go through” to get certified.
[READ: Does Acupuncture Work for Anxiety?]
Medicare Coverage for Other Types of Alternative Medicine
Medicare may cover some alternative medicine approaches, including:
— Chiropractic services
— Naturopathic medicine
— Massage therapy
Chiropractic services
Original Medicare (Part B) covers chiropractic care for manual manipulation of the spine to correct a vertebral subluxation, a condition where the spinal joints don’t move correctly but the joints still remain in contact — meaning there isn’t a complete dislocation or separation of the spinal joints.
You’re responsible for 20% of the Medicare-approved amount after you’ve met your Medicare Part B deductible.
There are several limitations regarding coverage for chiropractic care. Medicare doesn’t cover other chiropractic treatments and services such as:
— Chiropractic treatments unrelated to spinal subluxation or misalignment, such as general wellness treatments or conditions not involving the spine
— Therapeutic massage performed by a chiropractor
— Acupuncture or dry needling performed by a chiropractor
— Rehabilitation and exercise programs administered by a chiropractor
— X-rays ordered by a chiropractor
Naturopathic medicine
Medicare does not cover visits to naturopathic doctors, as the federal health insurance program does not recognize naturopaths as a provider category eligible for reimbursement.
Massage therapy
Medicare doesn’t cover any form of massage therapy. You are responsible for 100% of costs associated with therapeutic massage services.
Supplementary Insurance and Alternative Medicine
Other coverage beyond original Medicare may cover alternative medicine treatments.
— Medicare Advantage (Part C)
— Medigap
— Other insurance options
Medicare Advantage (Part C)
As a baseline, Medicare Advantage plans generally must cover at least the same benefits as original Medicare (Parts A and B) for hospital and medical services.
Some Medicare Advantage plans may offer broader coverage for acupuncture or other alternative therapies beyond what original Medicare provides. Coverage details — including costs, limits and providers — can vary significantly by plan, so it’s important to check with your specific plan provider for more information.
However, that doesn’t necessarily mean you should swap original Medicare coverage for a Medicare Advantage plan.
“I would always tell a person that’s choosing to switch from original Medicare to Medicare Advantage simply because of the optional benefits to think twice,” Omdahl says. “Those optional benefits are optional — plans don’t have to provide them.”
With that, she emphasizes that plans change from year to year. Just because certain services are covered one year doesn’t guarantee coverage the following year, so make sure to weigh the medical care coverage versus “free” benefits when weighing your plan options.
Medigap policies
Medigap policies, also known as Medicare supplemental insurance, are designed to cover out-of-pocket expenses, such as copayments, coinsurance and deductibles that original Medicare doesn’t cover. Medigap, for instance, can help you pay for that remaining 20% of costs if you qualified for acupuncture treatment. You must have original Medicare to purchase a Medigap policy.
Other insurance or payment options
Beyond Medicare Advantage plans and Medigap policies, some older adults might explore other supplement insurance plans or employer-provided health benefits that offer alternative medicine coverage.
Private health insurance plans, wellness programs or flexible spending accounts may provide some level of coverage or reimbursement for alternative medicine therapies. Review the specific terms of your individual insurance plan or contact your plan provider for more information, as coverage can vary widely depending on insurer and policy.
Additionally, some offices may offer cost-effective subscription plans for services. For example, Omdahl points to chiropractic company chains that offer a membership option, where you pay a fee and can visit the office a certain number of times per month or calendar year.
Questions to Ask Your Insurer
Always ask your insurance provider questions — both when you’re shopping around for a new plan and to clarify coverage for an existing plan.
The National Center for Complementary and Integrative Health suggests the following questions:
— Is this alternative medicine approach covered for my health condition?
— Does this type of alternative medicine treatment need to be preauthorized or preapproved, does it need to be ordered by prescription and/or do I need a referral?
— Does my plan require the practitioner to be in network? Do you have a list of providers available who accept my plan?
— Do I have out-of-network coverage for this alternative medicine service?
— Are there any limits and requirements? For example, there may be a limit on the number of visits — like how acupuncture coverage under specific conditions allows for coverage of up to 12 visits within 90 days.
— How much will I owe in out-of-pocket costs?
NCCIH also emphasizes the importance of keeping a written record of any communication with your insurance provider, in case coverage is denied and you need to submit a claim dispute down the road. Keep documentation of any:
— Notes during a phone call
— Copies of bills
— Copies of claims
— Copies of letters
— Any email or online portal communication
The Bottom Line
Original Medicare doesn’t cover most alternative medicine treatments, but there are a few exceptions. Medicare Advantage plans or private health insurance may offer additional coverage benefits for alternative medicine therapies.
It’s important to check with your health insurance plan provider for more information, as individual policies and insurers can vary significantly.
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Does Medicare Cover Acupuncture and Other Alternative Medicine? originally appeared on usnews.com
