Acupuncture and Chiropractic are alternative ways to help with pain management. Out of pocket costs for chiropractic and acupuncture can add up, so many people are left wondering if Original Medicare covers them.
Does Medicare Cover Acupuncture?
Medicare technically does cover acupuncture. Historically, Medicare only offered coverage for physical, occupational, and speech therapy. In 2020, accupuncture was approved for Medicare coverage but it may still be difficult for your current accupuncturist to be reimbursed by Medicare.
A acupuncture provider must be a MD, DO, physician assistant, nurse practitioner, clinical nurse specialist, or auxiliary person with a master’s or doctoral-level degree in acupuncture or Oriental Medicine from an ACAOM-approved school. They must also have an unrestricted active license to practice acupuncture in the state. Any acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by regulations.
If you can satisfy the above, Part B would cover up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare defines chronic back pain as follows:
- Lasting 12 weeks or longer
- Having no identifiable systemic cause (not associated with metastatic, inflammatory, or infectious disease)
- Pain that’s not associated with surgery or pregnancy
An additional 8 sessions will be covered if the person shows improvement. If the doctor decides the chronic low back pain isn’t improving or is getting worse, then Medicare won’t cover the treatments. No more than 20 acupuncture treatments can be given yearly. Source
Does Medicare Cover Chiropractic Care?
Medicare does cover medically necessary chiropractic services. According to the CMS, Medicare Part B covers 80% of the cost for “manipulation of the spine if medically necessary to correct a subluxation.” There is no cap on the number of medically necessary visits to a chiropractor.
Under Original Medicare, without any additional insurance, you would have to pay your part B deductible and 20% coinsurance for all medically necessary chiropractic appointments.
Does Medigap cover Chiropractic and Acupuncture?
Medigap plans do not cover acupuncture, except for Medigap Innovative G in California. However, they do cover chiropractic care. Medigap Plan F and Plan C cover 100% of your Part B deductible and will also pay the 20% coinsurance. Combined with Medicare there will be no charge for any medically necessary chiropractic work.
Do Medicare Advantage Plans Cover Chiropractic and Acupuncture?
Medicare Advantage (MA) plans may cover acupuncture or chiropractic care. Since MA are not standardized, each plan can offer a very different set of fees and benefits.
Plans that cover acupuncture are very rare but worth searching for if that is a high priority. Chiropractic is usually available under MA but how much you will pay can vary by plan.
For help tracking down supplemental insurance or if you have additional questions about alternative treatment, please call a Senior65 independent agent at 800-930-7956.
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