Acupuncture is a form of TCM (Traditional Chinese Medicine) in which the practitioner uses tiny needles inserted into the patient’s skin to offer pain relief and other health benefits. Acupuncture is typically categorized as alternative medicine, rather than medically necessary care, so it may not be covered by all health insurers.
An initial visit will take around an hour, with follow-up visits lasting around 30 minutes. You can expect your practitioner to apply 5 to 20 needles at various pressure points around your body and leave them in for 10 to 20 minutes. This doesn’t usually hurt, and is intended to stimulate nerves and may encourage the production of natural painkillers.
Although acupuncture is not recognized as part of Western medicine, some medical doctors may recommend it for pain relief. Acupuncture practitioners must be licensed by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), and a typical session can cost anywhere from $50-95.
If your doctor recommends an acupuncture treatment, or you’re curious to try it out, you’ll want to know whether your Medicare coverage will pay for it. Let’s take a look at which plans cover acupuncture and which don’t, and what other options you have for coverage.
MEDICARE COVERAGE FOR ACUPUNCTURE
Original Medicare (Parts A & B) covers inpatient and outpatient care that is deemed “medically necessary.” Under current guidelines, Medicare does not consider acupuncture to be medically necessary, so if you decide to get it, you’ll have to pay for the treatment out-of-pocket.
According to the Centers for Medicare & Medicaid Services (CMS), “Although acupuncture has been used for thousands of years in China and for decades in parts of Europe, it is a new agent of unknown use and efficacy in the United States. Even in those areas of the world where it has been widely used, its mechanism is not known.”
As a result, Medicare will not reimburse for acupuncture treatments until more scientific studies have been completed into the safety and effectiveness of the practice.
This doesn’t mean that Medicare won’t cover treatment for your condition. You may be covered for other forms of treatment for your symptoms, such as physical or occupational therapy. But if you decide to get an acupuncture treatment, even with a doctor’s recommendation, you won’t be covered for it under Original Medicare.
While that’s disappointing, the good news is that acupuncture treatments may be covered under some Medicare Advantage (Part C) policies, which we’ll look at later in this article.
WHAT ABOUT CHIROPRACTIC CARE?
Another form of alternative medicine that you may seek out for pain relief is chiropractic care. Unlike acupuncture, chiropractic care is covered under Medicare Part B, but only under very limited conditions and not for regular chiropractic visits.
Many patients visit the chiropractor to treat lower back or neck pain, or chronic headaches. The chiropractor applies force to the spine in a process called spinal manipulation that may improve your range of motion, but can cause complications in some patients. The average chiropractic session costs $65, and you may have to make multiple visits for the most effective results.
The only time that Original Medicare will pay for chiropractic treatment is to treat a condition called a “subluxation,” when deemed medically necessary by a doctor. A subluxation of the spine means that the bones are out of alignment, which can cause chronic pain. It can be identified either by an X-ray or by a manual exam.
According to the CMS, chiropractic care may be covered for acute or chronic cases, but “the manipulative services rendered must have a direct, therapeutic relationship to the patient’s condition and provide a reasonable expectation of recovery or improvement of function.”
If your doctor prescribes a chiropractic visit for a subluxation, it will be covered under Medicare Part B. As with other Part B coverage, Medicare will pay 80% and you’ll pay 20% coinsurance. You’ll also be responsible for the Part B deductible, which is $185 per year.
Medicare won’t cover any tests that your chiropractor orders, such as X-rays, so make sure that your visit is limited to a subluxation treatment, or you’ll have to pay for any other services out of pocket. Your chiropractor must be Medicare-certified in order for your treatment to be covered, and you may only be covered for a limited number of visits.
After you’ve reached a point where additional improvement is no longer expected, future visits are considered “maintenance therapy” and are no longer covered.
Remember, this only applies to Medicare Part B. If you have a Medicare Advantage plan (Part C), you may have more extensive coverage for chiropractic treatments. If you’re unsure, you can always call up your insurer and ask about your policy.
COVERING ACUPUNCTURE AND CHIROPRACTIC CARE WITH MEDIGAP
Medicare Supplement Insurance, or Medigap, refers to policies that offer additional coverage to fill in some of the “gaps” that Original Medicare doesn’t cover. You can enroll in a Medigap plan when you first sign up for Medicare, or if you meet certain special enrollment conditions.
Since Medigap plans are standardized from state-to-state, it’s easy to see what your costs will be for each plan. While Medigap doesn’t offer additional benefits related to chiropractic care or acupuncture, it does cover the 20% coinsurance for Medicare-approved services.
This means that, for a medically necessary visit to a chiropractor to treat a subluxation, Original Medicare Part B will cover 80% and your Medigap policy will cover the remaining 20%.
You’ll still be responsible for the $185 annual deductible, unless you have Medigap Plan F or C, which covers that as well, reducing your out-of-pocket costs for the treatment to zero.
Unfortunately, since acupuncture treatments are not covered by Original Medicare at all, your Medigap policy won’t cover them either. If you want more extensive coverage for acupuncture and chiropractic care, then you’ll have to look into a Medicare Advantage policy.
MEDICARE ADVANTAGE AND ACUPUNCTURE
Medicare Advantage plans are more varied than Medigap, and they may cover chiropractic care and acupuncture in some circumstances. Since Medicare Advantage plans aren’t standardized, however, it isn’t as easy to figure out your coverage as it is with a Medigap policy.
Before seeking out acupuncture or chiropractic treatment, you’ll want to find out whether your plan will cover it, and what the conditions and fees are. Your Medicare Advantage plan is more likely to cover alternative medicine if you live in an area where these services are common.
Some plans cover chiropractic care with less limiting conditions than Original Medicare. That means you may be able to see a chiropractor for other conditions besides subluxation, but you may be responsible for a deductible or copay. You may still need a referral from your regular doctor in order for your chiropractic visit to be covered.
Most Medicare Advantage plans don’t cover acupuncture, but some do. If your plan has vision and dental coverage, or includes preventive care, then it may also cover acupuncture and other alternative medicines. However, plans that cover more services typically have higher monthly premiums, so keep that in mind when deciding whether to switch to a new plan.
HOW TO GET COVERED FOR ACUPUNCTURE
If you’re already paying for acupuncture or chiropractic treatments out-of-pocket, or suspect you may need them in the future, then look for a Medicare Advantage plan that covers them. Paying a higher monthly premium may be worth it if you expect to use these treatments regularly.
You have more flexibility to switch between Medicare Advantage plans that you do with Original Medicare and Medigap, so be sure to check your coverage each year to find out if it’s changed or if another plan offers more extensive coverage.
If you want to switch to a plan that covers acupuncture or chiropractic care, you can only do that during the Open Enrollment Period, which takes place twice per year.
Another option is to see if these services will be covered by any secondary insurance you have, such as a spouse’s insurance plan or by federal employee health coverage.
Acupuncture and chiropractic care isn’t typically covered by Medicare, which is disappointing for people who rely on these treatments for joint care or pain relief. If you’re on Original Medicare or a Medigap plan, then you’ll have to pay out-of-pocket for most forms of traditional medicine.
However, some Medicare Advantage plans do cover acupuncture, and even more of them may cover chiropractic care. You’ll have to do some searching — and will likely pay a higher monthly premium — but it’s a good option if you want to have chiropractic or acupuncture coverage.
If you aren’t sure whether your current plan covers these treatments, or you just want to explore your options, reach out to the team at The Medicare Store. Fill out the contact form and one of our licensed insurance agents will get back to you soon to help answer your questions.
Whether this is your first time enrolling in Medicare, or you already have a plan and you want to compare it to other policies, our experienced team members will help you figure it out.