Is the Risk of Medicare Advantage Plans Worth It?
September 6, 2022Is Life Alert covered by Medicare?
September 8, 2022Is Acupuncture Covered by Medicare?
Except for seniors with unexplained lower back pain, and only for a limited time, the answer is no.
Except in one very limited circumstance and for a limited number of visits per year, Medicare Part B (medical insurance) does not cover acupuncture. The number of treatments you receive is also determined by your doctor's assessment of your progress.
In an effort to increase access to alternatives to prescription opioids for pain relief, Medicare began covering acupuncture specifically for lower back pain in 2020.
What Exactly Is Acupuncture?
Acupuncture is a traditional Chinese medical practice that involves inserting very thin needles through the skin at specific points on the body. It can be used to treat pain or to promote overall wellness, including stress reduction. Practitioners believe that by inserting needles at strategic points, they can help balance the flow of energy through the body.
When Is Acupuncture Covered By Medicare?
Medicare Part B will only cover acupuncture for chronic low back pain, which Medicare defines as:
•lasting at least 12 weeks
•There is no known cause (for example, it is not caused by an inflammatory disease).
•Pain unrelated to surgery or pregnancy
You must receive acupuncture from a doctor or health care provider who meets both of the following requirements:
•A master's or doctoral degree in acupuncture or Oriental medicine from a school accredited by the Accreditation Commission for Acupuncture and Oriental Medicine is required.
•A current, full, active, and unrestricted acupuncture license in the state where you are receiving care.
What Are The Medicare Acupuncture Coverage Limitations?
Medicare will pay for up to 12 visits in 90 days, plus an additional eight visits if you're getting better. If your doctor believes your back pain isn't improving or is worsening, Medicare will not cover the additional eight visits. Medicare will only cover up to 20 acupuncture treatments per year.
The majority of the cost for lower back pain treatments is covered by Medicare Part B. If you have a Medigap policy, it will cover your portion of the cost. Otherwise, you'd be on the hook for the remaining 20%.
Is Acupuncture Covered By Medicare Advantage?
Medicare Advantage plans, also known as Medicare Part C plans, are required to provide the same coverage as Medicare Parts A and B, and they may also provide additional benefits. As a result, this specific treatment for lower back pain will be covered by your Medicare Advantage plan.
A few Medicare Advantage plans have begun to include coverage for more than 20 acupuncture treatments per year. Check with your plan provider to see if acupuncture is covered under special circumstances or if it covers more treatments.