Acupuncture is an ancient practice that has gained popularity in modern medicine. Many people turn to acupuncture for pain relief and overall wellness. But if you rely on Medicare for your healthcare, you might wonder if this service is covered.
Understanding Medicare and Acupuncture Coverage
Medicare provides federal health insurance for people aged 65 and older. It also covers some younger individuals with disabilities. However, Medicare strictly regulates what treatments it covers.
For many years, Medicare did not include acupuncture in its benefits. That changed in 2020 when Medicare started covering acupuncture for certain conditions. However, this coverage comes with limits.
When Does Medicare Cover Acupuncture?
Medicare covers acupuncture only for chronic lower back pain. To qualify, your pain must:
- Have lasted 12 weeks or more
- Have no clear cause, like cancer or surgery
- Not be related to pregnancy
If you meet these conditions, Medicare Part B may help pay for acupuncture. You can receive up to 12 sessions in 90 days. If you show improvement, Medicare may cover eight more sessions. However, Medicare will not cover more than 20 treatments per year.
Who Can Provide Covered Acupuncture Services?
Medicare only covers acupuncture performed by specific providers. These include:
- Doctors
- Nurse practitioners
- Physician assistants
These professionals must have training in acupuncture. Medicare does not cover treatments from licensed acupuncturists unless they meet these conditions.
The needle is not a magic bullet, but it can help the body heal itself.
Dr. Richard Niemtzow
What Does Medicare Not Cover?
Medicare does not cover acupuncture for any other conditions besides chronic lower back pain. That means if you seek acupuncture for headaches, arthritis, or anxiety, you will need to pay out of pocket.
Additionally, Medicare does not cover:
- Herbal treatments
- Acupuncture supplies
- Alternative therapies related to acupuncture
How Much Will Acupuncture Cost With Medicare?
If Medicare covers your acupuncture, you will still have some costs. You must pay your Part B deductible before coverage begins. After that, Medicare pays 80% of the approved amount. You will be responsible for the remaining 20%, unless you have supplemental insurance.
Are There Other Insurance Options for Acupuncture?
Some Medicare Advantage (Part C) plans offer additional acupuncture benefits. These plans are provided by private insurance companies. They may cover acupuncture for other conditions, but coverage varies by plan.
If you want more acupuncture coverage, check different Medicare Advantage plans. You may find one that meets your needs.
Alternative Pain Management Options
Chiropractic Treatment and Massage
Chiropractic treatment is the most common nonsurgical treatment for back pain. Improvements in people undergoing chiropractic manipulations were noted in some trials. However, the treatment’s effectiveness in treating chronic back and neck pain isn’t supported by compelling evidence from the majority of clinical trials.
Therapeutic Touch and Reiki Healing
Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so called “energy-based” techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient. In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health.
Nutritional Supplements
There is some evidence indicating that glucosamine sulfate and chondroitin sulfate may be marginally effective for knee osteoarthritis, but other studies have found no benefit at all. These natural compounds were found to be well-tolerated and safe. Other dietary supplements, such as fish oils, also showed some early evidence of benefit, although more research is needed.
The Future of Acupuncture Coverage in Medicare
In 2020, the Centers for Medicare & Medicaid Services (CMS) officially declared that Medicare would cover acupuncture for patients with chronic low back pain. This decision was made as part of an effort to support alternative, non-opioid pain therapies as well as aid in reducing the risk for opioid dependency. If the doctor that referred you believes that your chronic back pain is improving due to the acupuncture treatments, your Medicare plan may cover up to eight additional treatments. In total, Medicare Part B may cover a maximum of 20 acupuncture treatments per calendar year.
The Medicare coverage of acupuncture for chronic low back pain is likely to continue and potentially expand as the US government seeks to address the opioid epidemic and promote alternative pain management options. Future policy decisions may also lead to increased access to acupuncture coverage for other conditions, such as migraines, fibromyalgia, and cancer treatment side effects.
Final Thoughts
Acupuncture can be an effective treatment for pain relief. Medicare provides limited coverage, but only for chronic lower back pain. If you need acupuncture for other reasons, you may have to explore alternative options.
Understanding Medicare’s rules helps you make better healthcare choices. If acupuncture is important to you, consider researching Medicare Advantage plans for expanded coverage.
