Does Medicare Cover Acupuncture?
Yes but navigating this is complicated. To fully answer the question, does medicare cover Acupuncture, you will need three pieces of information, what type of Medicare Plan(s) do you have, what type of provider are you looking to get help from and what condition are you seeking help for. Run and grab you insurance cards and when you return I’ll be here to talk all things Medicare Acupuncture.
Which Medicare Plans Pay for Acupuncture?
First what type of Medicare plan do you have? If you have Medicare Part B, you will have up to 20 visits per year for chronic low back pain only. Medicare part B does not provide Acupuncture benefits for any other condition.
If you have a supplemental plan, they typically provide coverage for the exact same benefits as Medicare but reduce your cost share.
Medicare Advantage plans or Medicare Part C plans are all different. Many do cover Acupuncture treatments. The scope of coverage and the type of providers you can see is usually broader if you have Acupuncture coverage included with you plan.
What Type of Provider Can You See for Acupuncture with your Medicare Plan?
If you are planning to use your Medicare Part B or a supplemental plan, you will need to see a Medical Doctor (MD), an Acupuncturist supervised by a Medical Doctor, A Nurse Practitioner that is also a Licensed Acupuncturist or a Chiropractor that is also a Licensed Acupuncturists. Currently Acupuncturists can not bill Medicare Part B or supplemental plans directly and thus need to do so under a MD’s supervision. It’s in the works for this to change but it requires a legislative act, likely not this year.
Licensed Acupuncturists can bill Medicare Advantage plans or Medicare Part C plans directly. This is great news as these plans often have broader coverage.
What Type of Conditions can you get Medicare Coverage for Acupuncture?
As mentioned above Medicare Part B and Supplemental plans only cover Acupuncture for low back pain.
Medicare Advantage plans and Medicare Part C plans have broader range of coverage and vary by plan. The only way to confirm coverage is to review your plan documents or call your health insurance company. These plans are very similar to commercial health insurance plans. In order to be assured coverage, you will need to confirm that your plan has an Acupuncture benefit and that your plan covers Acupuncture for the condition you are seeking help with. A third factor related to coverage: Is your provider in-network for out of network?
This a complicated topic and I wrote a separate blog post on Acupuncture Insurance Coverage here.
Checking Your Medicare Benefits
Checking your Medicare benefits can be complicated. Thus, many providers will do this for you. If you’re local to one of our offices, feel free to reach out to us and we’d be happy to check your benefits for you.
